Diane Lorenzo1, Frédérique Maire2, Carmen Stefanescu2, Jean-Marc Gornet3, Philippe Seksik4, Mélanie Serrero5, Barbara Bournet6, Philippe Marteau4, Aurelien Amiot7, David Laharie8, Caroline Trang9, Benoit Coffin10, Guy Bellaiche11, Guillaume Cadiot12, Catherine Reenaers13, Antoine Racine14, Stephanie Viennot15, Arnaud Pauwels16, Guillaume Bouguen17, Guillaume Savoye18, Anne-Laure Pelletier19, Guillaume Pineton de Chambrun20, Pierre Lahmek21, Stéphane Nahon21, Vered Abitbol22. 1. Departement of Hepato-Gastroenterology, Hôpital Cochin, AP-HP, Paris, France. Electronic address: diane.lorenzo@gmail.com. 2. Departement of Hepato-Gastroenterology, Hôpital Beaujon, AP-HP, Clichy La Garenne, France. 3. Departement of Hepato-Gastroenterology, Hôpital Saint Louis, AP-HP, Paris, France. 4. Departement of Hepato-Gastroenterology, Hôpital Saint Antoine, AP-HP, Paris, France. 5. Departement of Hepato-Gastroenterology, Hôpital Nord, AP-HM, Marseille, France. 6. Departement of Hepato-Gastroenterology, Hôpital Rangueil, Toulouse, France. 7. Departement of Hepato-Gastroenterology, Hôpital Henri Mondor, AP-HP, Créteil, France. 8. Departement of Hepato-Gastroenterology, Hôpital Haut-Lévêque, Pessac, France. 9. Departement of Hepato-Gastroenterology, CHU Nantes, Nantes, France. 10. Departement of Hepato-Gastroenterology, Hôpital Louis Mourier, AP-HP, Colombes, France. 11. Departement of Hepato-Gastroenterology, CH d'Aulnay, Aulnay sous-bois, France. 12. Departement of Hepato-Gastroenterology, CHU Reims, Reims, France. 13. Departement of Hepato-Gastroenterology, CHU Liège, Liège, Belgium. 14. Departement of Hepato-Gastroenterology, CHU du Kremlin Bicêtre, AP-HP, Kremlin Bicêtre, France. 15. Departement of Hepato-Gastroenterology, CHU Caen, Caen, France. 16. Departement of Hepato-Gastroenterology, CH Gonesse, Gonesse, France. 17. Departement of Hepato-Gastroenterology, CHU Rennes, Rennes, France. 18. Departement of Hepato-Gastroenterology, CHU Rouen, Rouen, France. 19. Departement of Hepato-Gastroenterology, Hôpital Bichat AP-HP, Paris, France. 20. Departement of Hepato-Gastroenterology, CHU Montpellier, Montpellier, France. 21. Departement of Hepato-Gastroenterology, CH Montfermeil, Montfermeil, France. 22. Departement of Hepato-Gastroenterology, Hôpital Cochin, AP-HP, Paris, France.
Abstract
BACKGROUND & AIMS: Few people know of autoimmune pancreatitis (AIP), a rare disorder associated with inflammatory bowel diseases (IBD). We aimed to describe phenotype and outcomes of IBD and AIP when associated. METHODS: We performed a retrospective study of cases of AIP in IBD identified from the multicenter Groupe d'Etude Thérapeutique des Affections Inflammatoires du tube Digestif in Belgium and France from July 2012 through July 2015. Patients were diagnosed with AIP based on the International Consensus Diagnostic Criteria for AIP. A definitive AIP diagnosis was based on histological analysis of pancreatic resection specimens or samples collected by fine-needle aspiration during endoscopic ultrasound. Patients with probable type 1 AIP were identified based on imaging findings, clinical and/or radiologic responses to steroids, level of serum immunoglobulin G4, and involvement of other organs. Patients with probable type 2 AIP were identified based on imaging findings, clinical and/or radiologic responses to steroids, and association with IBD. The primary objective was to collect information on the characteristics of AIP in patients with IBD. We also compared features of patients with IBD with and without AIP in a case-control analysis, using multivariate analysis. RESULTS: We analyzed data from 91 individuals with AIP and IBD (47 women) seen at 23 centers (58 had ulcerative colitis [UC] and 33 Crohn's disease [CD]). Eighty-nine patients had type 2 AIP, and 2 patients had type 1 AIP. The mean age at diagnosis of AIP was 35 ± 12 years, and for IBD it was 32 ± 12 years. AIP preceded IBD in 19 patients (21%). Over a mean follow-up period of 5.7 ± 4.9 years, 31 patients (34%) relapsed, 11 patients (12%) developed diabetes, and 17 patients (19%) developed exocrine pancreatic insufficiency. In patients with UC, factors independently associated with AIP included proctitis (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.3-6.3; P = .007) and colectomy (OR, 7.1; 95% CI, 2.5-20; P = .0003). In patients with CD, AIP was significantly associated with fewer perianal lesions (OR, 0.16; 95% CI, 0.03-0.77; P = .023), non-stricturing non-penetrating CD (OR, 6.7; 95% CI, 1.25-33.3; P = .0029), and higher rate of colectomy (OR, 27.8; 95% CI, 3.6-217; P = .0029). CONCLUSIONS: In a multicenter retrospective analysis of patients with AIP and IBD, followed for an average of 5.7 ± 4.9 years, we found most to have type 2 AIP. Two-thirds of patients have UC, often with proctitis. One-third of patients have CD, often with inflammatory features. Patients with IBD and AIP have higher rates of colectomy than patients with just IBD.
BACKGROUND & AIMS: Few people know of autoimmune pancreatitis (AIP), a rare disorder associated with inflammatory bowel diseases (IBD). We aimed to describe phenotype and outcomes of IBD and AIP when associated. METHODS: We performed a retrospective study of cases of AIP in IBD identified from the multicenter Groupe d'Etude Thérapeutique des Affections Inflammatoires du tube Digestif in Belgium and France from July 2012 through July 2015. Patients were diagnosed with AIP based on the International Consensus Diagnostic Criteria for AIP. A definitive AIP diagnosis was based on histological analysis of pancreatic resection specimens or samples collected by fine-needle aspiration during endoscopic ultrasound. Patients with probable type 1 AIP were identified based on imaging findings, clinical and/or radiologic responses to steroids, level of serum immunoglobulin G4, and involvement of other organs. Patients with probable type 2 AIP were identified based on imaging findings, clinical and/or radiologic responses to steroids, and association with IBD. The primary objective was to collect information on the characteristics of AIP in patients with IBD. We also compared features of patients with IBD with and without AIP in a case-control analysis, using multivariate analysis. RESULTS: We analyzed data from 91 individuals with AIP and IBD (47 women) seen at 23 centers (58 had ulcerative colitis [UC] and 33 Crohn's disease [CD]). Eighty-nine patients had type 2 AIP, and 2 patients had type 1 AIP. The mean age at diagnosis of AIP was 35 ± 12 years, and for IBD it was 32 ± 12 years. AIP preceded IBD in 19 patients (21%). Over a mean follow-up period of 5.7 ± 4.9 years, 31 patients (34%) relapsed, 11 patients (12%) developed diabetes, and 17 patients (19%) developed exocrine pancreatic insufficiency. In patients with UC, factors independently associated with AIP included proctitis (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.3-6.3; P = .007) and colectomy (OR, 7.1; 95% CI, 2.5-20; P = .0003). In patients with CD, AIP was significantly associated with fewer perianal lesions (OR, 0.16; 95% CI, 0.03-0.77; P = .023), non-stricturing non-penetrating CD (OR, 6.7; 95% CI, 1.25-33.3; P = .0029), and higher rate of colectomy (OR, 27.8; 95% CI, 3.6-217; P = .0029). CONCLUSIONS: In a multicenter retrospective analysis of patients with AIP and IBD, followed for an average of 5.7 ± 4.9 years, we found most to have type 2 AIP. Two-thirds of patients have UC, often with proctitis. One-third of patients have CD, often with inflammatory features. Patients with IBD and AIP have higher rates of colectomy than patients with just IBD.
Authors: Yoon Suk Lee; Nam-Hoon Kim; Jun Hyuk Son; Jung Wook Kim; Won Ki Bae; Kyung-Ah Kim; June Sung Lee Journal: Intern Med Date: 2018-03-09 Impact factor: 1.271
Authors: Surinder S Rana; Rajesh Gupta; Ritambhra Nada; Pankaj Gupta; Rajinder Basher; Bhagwat R Mittal; Ravi Kumar Sharma; Amit Rawat Journal: Ann Gastroenterol Date: 2018-04-28