Gastroenterologie
a hepatologie

Autoimmune chronic pancreatitis and idiopathic bowel disease

David Solil¹, Petr Dítě¹, Tomáš Kupka^2,3, Marie Přecechtělová¹, Jiří Dolina ^{Orcid.org  1}, Bohuslav Kianička ^{Orcid.org  4}

+ Affiliation
¹ Interní gastroenterologická klinika LF MU a FN Brno
² Interní klinika LF OU a FN Ostrava
³ Katedra interních oborů, LF OU v Ostravě
⁴ II. interní klinika LF MU a FN u sv. Anny v Brně

Summary

Autoimmune pancreatitis (AIP) represents a special subgroup of chronic pancreatitis, characterized by a fibroinflammatory process of the pancreas affecting its exocrine and endocrine functions. This article focuses on clinical characteristics, diagnosis, and therapy of both types of AIP, with special emphasis on its association with idiopathic bowel disease (IBD). While the relationship between type 1 AIP and IBD is rare, it is significantly more common in type 2 AIP. Studies showed that the prevalence of AIP in IBD patients is higher compared to the general population and may significantly affect the course of underlying intestinal disease. Diagnostic challenges are presented by the similarity with pancreatic malignancies, which emphasizes the importance of a careful differential diagnosis. Corticosteroids remain the first choice in the treatment of AIP, with additional immunomodulatory therapies (azathioprime, rituximab) being considered in corticodependent patients. This article provides an overview of the current knowledge on the relationship between AIP and IBD and emphasizes the need for early diagnosis and a multidisciplinary approach in their management.

Keywords

inflammatory bowel disease, chronic pancreatitis, autoimmune pancreatitis, pancreatic endocrine insufficiency

To read this article in full, please register for free on this website.

Benefits for subscribers

Benefits for logged users

Literature

1. Shimosegawa T, Chari ST, Frulloni L et al. International consensus diagnostic criteria for autoimmune pancreatitis: guidelines of the Internal Association of Pancreatology. Pancreas 2011; 40(3): 352–358. doi: 10.1097/MPA.0b013e3182142fd2.
2. Massironi S, Fanatti I, Vigano C et al. Systematic review – pancreatic involvement in inflammatory bowel disease. Aliment Pharmacol Ther 2022; 55(12): 1478–1491. doi: 10.1111/apt.16949.
3. Fousekis FS, Theopistos VI, Katsamos KH et al. Pancreatic involvement in inflammatory bowel disease: a review. J Clin Med Res 2018; 10(10): 743–751. doi: 10.14740/jocmr3561w.
4. Spanier BW, Dijkgraaf MG, Bruno MJ. Epidemiology, aetiology and outcome of acute and chronic pancreatitis: an update. Best Pract Res Clin Gastroenterol 2008; 22(1): 45–63. doi: 10.1016/j.bpg.2007.10.007.
5. Majumder S, Takahashi N, Chari ST. Autoimmune pancreatitis. Dig Dis Sci 2017; 62(7): 1762–1769. doi: 10.1007/s10620-017-4541-y.
6. Ueki T, Kawamoto K, Otsuka Y et al. Prevalence and clinicopathological features of autoimmune pancreatitis in Japanese patients with inflammatory bowel disease. Pancreas 2015; 44(3): 434–440. doi: 10.1097/MPA.0000000000000261.
7. Park SH, Kim D, Ye BD et al. The characteristics of ulcerative colitis associated with autoimmune pancreatitis. J Clin Gastroenterol 2013; 47(6): 520–525. doi: 10.1097/MCG.0b013e31827fd4a2.
8. Uchida K, Okazaki K. Clinical and pathophysiological aspects of type 1 autoimmune pancreatitis. J Gastroenterol 2018; 53(4): 475–483. doi: 10.1007/s00535-018-1440-8.
9. Ravi K, Chari ST, Vege SS et al. Inflammatory bowel diasese in the setting of autoimmune pancreatitis. Inflamm Bowel Dis 2009; 15(9): 326–330. doi: 10.1002/ibd.20898.
10. Schneider A, Hirth M, Weiss C et al. Prevalence of inflammatory bowel disease in alcoholic, non-alcoholic and autoimmune pancreatitis. Z Gastroenterol 2018; 56(5): 469–478. doi: 10.1055/s-0043-123881.
11. Baresi L, Tacelli M, Grino SF et al. Multicentric Italian survey on daily practice for autoimmune pancreatitis: clinical data, diagnosis, treatment and evolution toward pancreatic insufficiency. United European Gastroenterol J 2020; 8(6): 705–715. doi: 10.1177/2050640620924302.
12. Almeida P, Almeida C, Gompertz M et al. Association between autoimmune pancreatitis and ulcerative colitis: report of 12 patients. Rev Esp Enferm Dif 2020; 112(9): 682–687. doi: 10.17235/reed.2020.6677/2019.
13. Lorenzo D, Maire F, Srefanescu C et al. Features of autoimmune pancreatitis associated with inflammatory bowel disease. Clin Gastroenterol Hepatol 2018; 16(1): 59–67. doi: 10.1016/j.cgh.2017.07.033.
14. Tsen A, Alishahi Y, Rosenkranz L. Autoimmune pancreatitis and inflammatory bowel disease: an update overview. J Clin Gastroenterol 2017; 51(3): 208–214. doi: 10.1097/MCG.00000 00000000737.
15. Sah RP, Chari ST, Pannala R et al. Differences in clinical profile and relapse rate of type 1 versus type 2 autoimmune pancreatitis. Gastroenterology 2010; 139(1): 140–148. doi: 10.1053/j.gastro.2010.03.054.
16. Overbeek KA, Poulsen JL, Lanzillotta M et al. Type 1 autoimmune pancreatitis in Europe: clinical profile and response to treatment. Clin Gastroenterol Hepatol 2024; 22(5): 994.e10–1004.e10. doi: 10.1016/j.cgh.2023.12.010.
17. Chiabrando F, Lanzillota M, Palumbo D et al. Treating type 2 autoimmune pancreatitis with colchicine: a case series. Ann Intern Med 2021; 174(12): 1775–1776. doi: 10.7326/L21-0281.
18. Lorenzo D, Vullierme MP, Rebours V. Antitumor necrosis factor therapy is effective for autoimmune pancreatitis type 2. Am J Gastroenterol 2020; 115(7): 1133–1134. doi: 10.14309/ajg.0000000000000668.
19. Singh VK, Haupt ME, Geller DE et al. Less common etiologies of exocrine pancreatic insufficiency. World J Gastroenterol 2017; 23(39): 7059–7076. doi: 10.3748/wjg.v23.i39.7059.
20. Maconi D, Dominici R, Molteni M et al. Prevalence of pancreatic insufficiency in inflammatory bowel disease. Dig Dis Sci 2008; 53(1): 262–270. doi: 10.1007/s10620-007-9852-y.
21. Lorenzo D, Vullierme MP, Rebours V. Antitumor necrosis factor therapy is effective in autoimmune pancreatitis type 2. Am J Gastroenterol 2020; 115(7): 1133–1144. doi: 10.14309/ajg.0000000000000668.
22. Angelini G, Cavallini G, Bovo P et al. Pancreatic function in inflammatory bowel disease. Int J Pancreatology 1988; 3(2–3): 185–193. doi: 10.1007/BF02798930.
23. Heikius B, Niemela S, Lehtola M et al. Pancreatic duct abnormalities and pancreatic function in patients with chronic inflammatory bowel disease. Scand J Gastroenterol 1996; 31(5): 517–523. doi: 10.3109/00365529609006775.
24. Hegenhoj J, Hansen CP, Rannem T et al. Pancreatic function in Crohn‘s disease. Gut 1990; 31(9): 1076–1079. doi: 10.1136/gut.31.9.1076.
25. Seibold F, Mork H, Tanza S et al. Pancreatic autoantibodies in Crohn‘s disease: a family study. Gut 1997; 40(4): 481–484. doi: 10.1136/ gut.40.4.481.
26. Hedström A, Steiner C, Valente R et al. Pancreatic exocrine insufficiency and Crohn‘s disease. Minerva Gastroenterol Dietol 2020; 66(1): 17–22. doi: 10.23736/S1121-421X.19.02636-9.
27. Buldukoglu OC, Alparslan AS, Koc LZ et al. Prevalence of pancreatic steatosis in inflammatory bowel disease patients. Sisli Etfal Hstan Tip Bul 2024; 58(4): 442–446. doi: 10.14744/SEMB.2024.43726.