Autoimmune pancreatitis (AIP) is a rare, but chronic inflammatory disorder of the pancreas. It is caused due to the body’s own defense mechanism attacking the pancreas. They are of two types namely, type I AIP and type II AIP. Type I affects multiple organs along with pancreas while type II affects only the pancreas.
The exact cause of autoimmune pancreatitis is not known, but it is due to the immune cells attacking your own pancreatic cells, similar to the other autoimmune diseases.
Gender: The condition is predominant in males when compared to females
Age: Occurs in your 60’s and 70’s
Type II AIPGender: The condition is equally likely in both males and females
Age: Occurs in your 40’s and above
If a timely treatment is not made available for the patient with autoimmune pancreatitis, then the following complications can occur:
Diabetes: In autoimmune pancreatitis, the insulin production is affected due to the damage to the pancreas. This can lead to diabetes, and the patient may require oral anti-diabetic medications or insulin injections. Pancreatic insufficiency: As the ability of the pancreas to produce adequate enzymes is affected in AIP, the patient may have diarrhea, weight loss, vitamin or mineral deficiency and metabolic bone disease.Pancreatic calcifications or stones formation can occur in the pancreas over time.
The treatments such as long-term steroids used for AIP management also can cause certain complications. However, the life expectancy of the patients treated is normal.
An accurate diagnosis of autoimmune pancreatitis is important as it has similarities with pancreatic cancer. Underdiagnosis can lead to the delay in treatment or a wrong treatment.
Type I AIPYou have type I AIP, if your diagnostic tests shows:
You have type II AIP, if your diagnostic tests shows:
An endoscopic biopsy has to be done for a definitive diagnosis of type II AIP. During the biopsy, the distinctive appearance of the pancreatic tissue is identified under the microscope which indicates type II AIP.
Before the autoimmune pancreatitis treatment begins, a biliary stent is inserted to drain the bile from the ducts in case if obstructive jaundice is identified.
Steroidal therapy: Autoimmune pancreatitis is highly responsive to steroidal therapy. It regresses or resolves with treatment using steroids. A short course of prednisolone improves the symptoms of AIP. People with type I respond faster to the treatment with steroids compared to those with type II. However, the chances of relapse after the treatment is more in type I.Steroids also can treat the extrapancreatic manifestations which need continuous monitoring.
Immunosuppressants or immune modulators may be used in case of relapse of AIP which is possible in 30-50% of the patients treated with steroids. As long-term treatment with steroids can lead to serious side effects, immune suppressing agents such as mercaptopurine, azathioprine, mycophenolate, and rituximab are given.
For patients with pancreatic insufficiency, supplementary enzymes are given.
If diabetes has occurred as a complication of AIP, then appropriate anti-diabetic medication will be given.
The signs and symptoms of autoimmune pancreatitis and pancreatic cancer are similar, but the treatments are different for both. Therefore, it is important to distinguish them.
Autoimmune pancreatitis symptoms are usually not evident but include the following in the patients who have symptoms:
