Relapse following the withdrawal of treatment occurs in approximately 30% of patients with AIP.[19,69,70,74] Disease relapse can be divided into clinical (i.e., recurrent abdominal pain, jaundice, weight loss or involvement of another organ), radiological (i.e., focal/diffuse enlargement of pancreas or new biliary strictures) and serological relapse (i.e., elevation of serum IgG4). Relapses can occur in the pancreas or in other organs (e.g., biliary tree or retroperitoneum). We do not advocate cross-sectional imaging or serological testing if the patient does not have clinical symptoms after corticosteroid treatment. Approximately 30-40% of the patients with clinical or radiological relapse require a second prolonged course of corticosteroids. Some patterns of AIP involvement may predict subsequent relapse. It is known that involvement of the proximal bile duct (i.e., proximal extrahepatic and intrahepatic ducts) has a higher relapse rate than intrapancreatic biliary involvement. A recently published study discovered that the substitution of aspartic acid at position 57 of the DQB1 gene may be a predicting factor for relapse. There are very limited data that currently exist on long-term treatment relapses and morbidity of the disease. Thus, at the present time, there are more questions than answers regarding both treatment protocols and long-term outcomes. We are confident that, as the collective experience with AIP increases, these issues will be ironed out.
Expert Rev Gastroenterol Hepatol. 2009;3(2):197-204. © 2009 Expert Reviews, Ltd.
Cite this: Autoimmune Pancreatitis: An Update - Medscape - Apr 01, 2009.