Gastroenterologie
a hepatologie

Inflammatory bowel disease and autoimmune pancreatitis

Tomáš Kupka^1,2, Petr Dítě³, David Solil³, Martina Bojková¹, Jiří Dolina ^{Orcid.org  3}, Bohuslav Kianička ^{Orcid.org  4}

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

Summary

Autoimmune pancreatitis is a subtype of chronic pancreatitis. Currently, type 1 is known (LPSP – lymphoplasmacytic sclerosing pancreatitis), which is classified among the clinical forms of a group of diseases designated as IgG4-related disease. This form occurs in younger individuals and IgG4 levels are normal with a few exceptions. This type is accompanied in 20–30% via findings of inflammatory bowel diseases, mainly ulcerative colitis. Type 3 autoimmune pancreatitis has been described, but it is still debated. The number of persons with inflammatory bowel diseases and the finding of type 2 autoimmune pancreatitis is highest in persons with ulcerative colitis – up to 2/3 of all patients. In the Mayo Clinic study, 19 persons with inflammatory bowel disease were found in a group of 43 patients with type 2 AIP; similarly, a Japanese study found AIP in 11 cases in a group of 52 patients with inflammatory bowel disease. Other studies have shown similar results. Inflammatory bowel disease with autoimmune pancreatitis is diagnosed in 20% of cases and steroid therapy is usually successful.

Keywords

inflammatory bowel disease, autoimmune pancreatitis type 1, autoimmune pancreatitis type 2

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Literature

1. Cassinotti A, Birindelli S, Clerici M et al. HLA and autoimmune digestive disease. A clinically oriented review for gastroenterologists. Am J Gastroenterol 2009; 104(1): 195–217. doi: 10.1038/ajg.2008.10.
2. Kunovsky L, Dite P, Jabandziev P et al. Autoimmune diseases of digestive organs: a multidisciplinary challenger: a focus on hepatopancreatobiliary manifestation. J Clin Med 2021; 10(24): 5796. doi: 10.3390/jcm10245796.
3. Zhang YZ, Liu YY. Inflammatory bowel disease: pathogenesis. World J Gastroenterol 2014; 20(1): 91–99. doi: 10.3748/wjg.v20.i1.91.
4. Kupka T, Kunovsky L, Novotny I et al. Idiopathic inflammatory bowel disease and the first type of autoimmune form of pancreatitis: case report. Vnitr Lek 2019; 65(7–8): 520–523.
5. Mahdi BM. Role of HLA typing on Crohn‘s disease pathogenesis. Ann Med Surg 2015; 4(3): 248–253. doi: 10.1016/j.amsu.2015.07.020.
6. Kuna AT. Serological markers of inflammatory bowel disease. Biochem Med 2013; 23(1): 28–42. doi: 10.11613/bm.2013.006.
7. Bjornson ES, Kalaitzakis E. Recent advances in the treatment of primary sclerosing cholangitis. Expert Rev Gastroenterol 2021; 15(4): 413–425. doi: 10.1080/17474124.2021.1860751.
8. Vavricka SR, Shoepfer A, Schari M et al. Extraintestinal manifestation of inflammatory bowel disease. Inflamm Bowel Dis 2015; 21(8): 182–192. doi: 10.1097/MIB.0000000000000392.
9. Fine S, Nee J, Thakuria P et al. A ocular and oral manifestation of inflammatory bowel disease. Dig Dis Sci 2017; 62(12): 3269–3279. doi: 10.1007/s10620-017-4781-x.
10. Halling ML, Kjeldsen J, Knudsen T et al. Patients with inflammatory bowel disease have increased risk of autoimmune and inlammatory disease. World J Gastroenterol 2017; 23(33): 6137–6146. doi: 10.3748/wjg.v23.i33.6137.
11. Iida T, Wagatsuma K, Hiayama J et al. The etiology of pancreatic manifestations in patients with inflammatory bowel disease. J Clin Med 2019; 8(7): 916. doi: 10.3390/jcm8070916.
12. Heikus B, Niemela S, Lehtola J et al. Elevated pancreatic enzymes in inflammatory bowel disease are associated with extensive disease. Am J Gastroenterol 1999; 94(4): 1062–1069. doi: 10.1111/j.1572-0241.1999.01015.x.
13. Hegnhoj J, Hansen PP, Rannem T et al. Pancreatic function in Crohn‘s disease. Gut 1990; 31(9): 1076–1079. doi: 10.1136/gut.31.9.1076.
14. Katz S, Bank S, Greenberg RE et al. Hyperamylasemia in inflammatory bowel disease. J Clin Gastroenterol 1988; 10(6): 627–630. doi: 10.1097/00004836-198812000-00010.
15. Bokemeyer B. Asymptomatic elevation of serum lipase and amylase in conjunction with Crohn‘s disease and ulcerative colitis. Z Gastroenterol 2002; 40(1): 5–10. doi: 10.1055/s-2002-19636.
16. Ball WP, Baggenstoss AH, Bargen KA. Pancreatic lesions associated with chronic ulcerative colitis. Arch Pathol 1950; 50(3): 347–358.
17. Whitcomb DC, Frulloni L, Garg P et al. An international draft consensus proposal for a new national definition. Pancreatology 2016; 16(2): 218–224. doi: 10.1016/j.pan.2016.02.001.
18. Chen YL, Hsu CW, Cheng CC et al. Increased subsequent risk of inflammatory bowel disease association in patients with chronic pancreatitis: a nationwide population-based cohort study. Curr Med Res Opin 2017; 33(6): 1077–1082. doi: 10.1080/03007995.2017.1300143.
19. Narula N, Vasudev M, Marshall JK et al. IgG4-related sclerosing disease: a novel mimic of inflammatory bowel disease. Dig Dis Sci 2010; 55(11): 3047–3051. doi: 10.1007/s10620-010-1287-1.
20. Lohr JM, Vujasinovic M, Rosendahl J et al. IgG4-related disease of the digestive tract. Nat Rev Gastroenterol Hepatol 2022; 19(3): 185–197. doi: 10.1038/s41575-021-00529-y.
21. Topal F, Yuksel E, Kinci N et al. The prevalence of IgG4-positive plasma cell infiltrates in inflammatory bowel disease patients without autoimmune pancreatitis. Turk J Gastroenterol 2014; 25(5): 558–562. doi: 10.5152/tjg.2014.5714.
22. Zhang L, Chari S, Smyrk TC et al. Autoimmune pancreatitis (AIP) type 1 and type 2: an international consensus study on histopathologic diagnostic criteria. Pancreas 2011; 40(8): 1172–1179. doi: 10.1097/MPA.0b013e318233bec5.
23. Brito-Teron P, Bosch X, Ramos-Casals M et al. IgG4-related disease: advances in diagnosis and treatment. Best Pract Res Clin Rheumatol 2016; 30(2): 261–278. doi: 10.1016/j.berh.2016.07.003.
24. Backhus J, Seufferlein T, Kleger A. IgG4-assoziierte Erkrankungen und Autoimmunpankreatitis. Gastroenterologie 2017; 13(3): 215–237. doi: 10.1055/s-0043-104462.
25. Notohara K, Burgart LJ, Yadav D et al. Idiopatic chronic pancreatitis with periductal lymphoplasmatic infiltration: clinipathologic features of 35 cases. Am J Surg Pathol 2003; 27(8): 1119–1127. doi: 10.1097/00000478-200308000-00009.
26. Hart PA, Levy MJ, Smyrk TC et al. Clinical profiles and outcomes in idiopathic duct-centric pancreatitis (type 2 autoimmune pancreatitis): the Mayo Clinic experience. Gut 2016; 65(10): 1702–1709. doi: 10.1136/gutjnl-2015-309275.
27. De Pertis N, Frulloni L. Autoimmune pancreatitis type 2. Curr Opin Gastroenterol 2020; 36(5): 417–420. doi: 10.1097/MOG.0000000000000655.
28. Lorenzo D, Maire F, Stefanescu C et al. Features of autoimmune pancreatitis associated with inflammatory bowel disease. Clin Gastroenterol Hepatol 2018; 16(1): 59–68. doi: 10.1016/j.cgh.2017.07.033.
29. Oh D, Song TJ, Moon SH. Type 2 autoimmune pancreatitis (idiopathic duct centric pancreatitis) highlighting patients presenting as acute pancreatitis: a single center experience. Gut Liver 2019; 13(4): 461–470. doi: 10.5009/gnl18429.
30. Ravi K, Chari ST, Vege SS et al. Inflammatory bowel disesase in the setting of autoimmune pancreatitis. Inflamm Bowel Dis 2009; 15(9): 1326–1330. doi: 10.1002/ibd.20898.
31. Fukuda S, Akiyama S, Tarakji A et al. Prevalence and clinical features of patients with autoimmune pancreatitis and inflammatory bowel disease: a systematic revue and meta-analysis. J Gastroenterol Hepatol 2022; 37(8): 1474–1484. doi: 10.1111/jgh.15894.
32. Sayed Amed A, Abreo M, Thomas A et al. Type 3 autoimmune pancreatitis (immune check-point inhibitor-induced pancreatitis). Curr Opin Gastroenterol 2022; 38(5): 516–520. doi: 10.1097/MOG.0000000000000873.
33. Lee AA, Gupta S, Labban M et al. Drug-induced acute pancreatitis due to medications used for inflammatory bowel disease: A VigiBase pharmacovigilance database study. Pancreatology 2023; 23(6): 569–573. doi: 10.1016/j.pan. 2023.06.003.
34. Ueki T, Kawamoto K, Otsuka Y et al. Prevalence of clinicopathological features of autoimmune pancreatitis in Japanese patients with inflamatory bowel disease. Pancreas 2015; 44(3): 434–440. doi: 10.1097/MPA.0000000000000261.
35. Kanno A, Masamune A, Okazaki K et al. Nationwide epidemiological survey of autoimmune pancreatitis in Japan in 2011. Pancreas 2015; 44(4): 535–539. doi: 10.1097/MPA.00000 00000000325.
36. Kamisawa T, Chari ST, Giday SA et al. Clinical profile of autoimmune pancreatitis and its histological subtypes: an internatrional multicenter survey. Pancreas 2011; 40(6): 809–814. doi: 10.1097/MPA.0b013e3182258a15.
37. Eder P, Verstock B, Culver E et al. Autoimmune Pancreatitis in Patients with Inflammatory Bowel Disease: A Real-World Multicentre Collaborative ECCO CONFER Study. J Crohns Colitis 2023; 17(11): 1791–1799. doi: 10.1093/ ecco-jcc/jjad097.
38. Nikolic S, Lanzillotta M, Panic N et al. Unraveling the relationship between autoimmune pancreatitis type 2 and inflammatory bowel disease: results from two centers and systematic review of the literature. United European Gastroenterol J 2022; 10(5): 496–506. doi: 10.1002/ueg2.12237.
39. 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.
40. Massironi S, Fanetti 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.
41. Chiabrando F, Lanzillotta 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.