Autoimmune Pancreatitis: An Update

Aravind Sugumar; Suresh Chari

Disclosures

Expert Rev Gastroenterol Hepatol. 2009;3(2):197-204. 

In This Article

Diagnosis

History & Timeline

As experience with AIP has increased, the diagnostic criteria have also evolved. It was in 1995 that the first steps to identify this condition were made by Yoshida et al..[4] This initial step was aimed at identifying some features suggestive of AIP. The first real guidelines for diagnosis AIP were the Japanese Pancreas Society (JPS) guidelines in 2002 and later modified in 2006.[67] The initial goal of these criteria was to insure the diagnosis of pancreatic cancer was not missed. It was subsequently realized that many patients diagnosed with AIP did not conform to the JPS criteria, thus exposing its limitations. In 2006, Chari and colleagues proposed the Mayo Clinic's Histology, Imaging, Serology, Other organ involvement and Response to therapy (HISORt) criteria followed by Korean diagnostic criteria published that same year.[19,45] In August 2008, the Asian consensus criteria was jointly proposed by the JPS and Korean Society for pancreato-biliary disease.[46] In this article, we discuss the HISORt and Asian Diagnostic Criteria 2008.

At the outset, it behooves us to reiterate the fact that AIP is a rare disease with a much lower rate of incidence than its chief differential diagnosis, pancreatic cancer. The gold standard to diagnose AIP is the distinct LPSP histology with tissue staining for IgG4 (> 10 cells/HPF).[15,19,60] Since the pancreas is not a readily amenable to core biopsy, all proposed criteria try to propose surrogate criteria so as to limit biopsy only to the most challenging of cases.

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