Autoimmune Pancreatitis: An Update

Aravind Sugumar; Suresh Chari

Disclosures

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

In This Article

HISORt Criteria

This criteria were proposed in 2006 by Chari et al. at the Mayo Clinic. HISORt is a mnemonic that stands for histology, imaging, serology, other organ involvement and response to therapy. Patients are diagnosed as having AIP if they fulfill at least one the sets of criteria.

Group A: Histology

Must fulfill at least one criteria. Pancreatic histology shows:

  • Lymphoplasmacytic infiltrate with storiform fibrosis and obliterative phlebitis (LPSP)

  • Lymphoplasmacytic infiltrate with storiform fibrosis showing abundant (≥10 cells/HPF) IgG4-positive cells

Group B: Imaging & Serology

Must fulfill all criteria:

  • CT scan/MRI showing diffusely enlarged pancreas with delayed and 'rim' enhancement

  • Pancreatogram showing diffusely irregular pancreatic duct

  • Elevated serum IgG4 levels (> 140 mg/dl)

Group C: Response to Steroids

Must fulfill all criteria:

  • Unexplained pancreatic disease after negative work-up for other known causes including cancer

  • Elevated serum IgG4 levels and/or other organ involvement confirmed by presence of abundant IgG4-positive cells

  • Resolution or marked improvement in pancreatic disease and/or extrapancreatic manifestation with steroid therapy

Based on these criteria, a wider range of clinical presentations could be captured.

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