The diagnostic criteria for chronic pancreatitis proposed by the Japan Pancreas Society (JPS) classified chronic pancreatitis into (i) definite; (ii) probable, and (iii) possible chronic pancreatitis, excluding obstructive, inflammatory (autoimmune) and tumor-forming pancreatitis from the definition of chronic pancreatitis. In the JPS Criteria, imaging studies, pancreatic function tests, and histological findings are independent of each other, and thus the diagnosis of chronic pancreatitis is made if one of the criteria is satisfied, regardless of the etiology of the chronic pancreatitis. The current diagnostic criteria for chronic pancreatitis depend on abnormalities of the duct system, such as low bicarbonate output, dilation of main pancreatic duct and duct branches, and calculi in the ducts by imaging studies. We revealed that the difference between reversible and irreversible pancreatitis in experimental animals is dependent on the degree of damage of the duct epithelium where pancreas progenitor cells exist. Thus, chronic pancreatitis diagnosed by the current criteria based on abnormalities of the duct system is irreversible. In contrast, the epithelium of the ducts is usually preserved in obstructive and autoimmune pancreatitis in that both structural and functional changes recover almost completely when the obstruction is removed or the inflammatory changes disappear following steroid administration. Even in chronic pancreatitis defined as irreversible, there must be a reversible stage during its clinical course. There is a need to develop biological markers and/or imaging procedure to detect chronic pancreatitis at its reversible stage.
"Over the last decade, many diagnostic criteria for AIP have been proposed and revised under various circumstances . In 2002, the first set of criteria for AIP diagnosis was established by the Japanese Pancreatic Society (JPS) (JPS 2002)  , which was subsequently revised in 2006 (JPS 2006) by the JPS and the nationally supported Research Committee of Intractable Diseases of the Pancreas . JPS 2002 and JPS 2006 consisted of three main items: characteristic imaging findings, serology, and pathological findings . "
[Show abstract][Hide abstract] ABSTRACT: Objectives. The recent International Consensus Diagnostic Criteria (ICDC) for autoimmune pancreatitis (AIP) and its Japanese amendment developed by the Japanese Pancreas Society (JPS 2011) may have overcome the drawbacks of earlier criteria and achieved a higher diagnostic ability for AIP. The aim of the present study is to evaluate this possibility and identify the underlying causes of this change. Methods. We compared the diagnostic abilities of the ICDC and JPS 2011 with those of the Japanese diagnostic criteria 2006 (JPS 2006), Korean diagnostic criteria (Korean), Asian diagnostic criteria (Asian), and HISORt diagnostic criteria in 110 patients with AIP and 31 patients with malignant pancreatic cancer. Results. The ICDC achieved the highest diagnostic ability in terms of accuracy (95.0%), followed by JPS 2011 (92.9%), Korean (92.2%), HISORt (88.7%), Asian (87.2%), and JPS 2006 (85.1%). Nearly all criteria systems exhibited a high specificity of 100%, indicating that the enhanced diagnostic ability of the ICDC and JPS 2011 likely stemmed from increased sensitivity brought about by inclusion of diagnostic items requiring no endoscopic retrograde pancreatography. The diagnostic ability of JPS 2011 was nearly equivalent to that of the ICDC. Conclusions. The ICDC and JPS 2011 have improved diagnostic ability as compared with earlier criteria sets because of an increase in sensitivity.
Gastroenterology Research and Practice 11/2013; 2013:456965. DOI:10.1155/2013/456965 · 1.75 Impact Factor
"MRCP seems to be the imaging modality of choice because of its superiority to CT in indentifying a fistula in the pancreatic region. Its noninvasive character is an advantage compared to endoscopic retrograde cholangiopancreatography [7, 8]. "
[Show abstract][Hide abstract] ABSTRACT: Two patients presented with dyspnea and signs of chronic pancreatitis. Patient B had pleural effusion on chest X-ray. Patient A developed pleural effusion during the course of disease. On further analysis these pleural effusions showed elevated amylase concentrations. This finding suggested the diagnosis of a pancreaticopleural fistula which was confirmed by magnetic resonance cholangiopancreatography. Because of the distinct localization of the fistulas the patients were treated differently. In patient A an endoprosthesis was successfully placed in the pancreatic duct, and patient B underwent distal pancreatic resection. Considering the rarity of pancreaticopleural fistula, there is no consensus on diverse aspects of treatment, such as length of treatment with octreotide. However, a rationale for the distinction between fistulas suited for treatment with endoprosthesis or surgery seems to provide some grip.
Case Reports in Gastroenterology 04/2009; 3(1):36-42. DOI:10.1159/000210442
"AIP is a systemic disease which, in addition to the pancreas, is known to affect multiple organs such as bile duct, cervical and abdominal lymph nodes, salivary gland, retroperitoneum, peripancreatic artery and vein [1, 6, 7]. Usually, this type of pancreatitis recovers structurally and functionally when the ductal obstruction is removed or the inflammation disappears after steroid administration . According to a Japanese nationwide survey , the incidence of AIP was 0.82 per 100,000 people in 2002, with a higher ratio of males (2.85 times that of females). "
[Show abstract][Hide abstract] ABSTRACT: A variety of extrapancreatic lesions have been associated with autoimmune pancreatitis (AIP), and these lesions can be difficult to diagnose. We report a patient referred to Shizuoka Cancer Center with the diagnosis of a possible biliary carcinoma with liver metastasis who was shown to have AIP accompanied by pseudotumors of liver. Clinical imaging revealed diffuse enlargement of the head of the pancreas with irregular narrowing of the main pancreatic duct and inferior common bile duct, multiple liver masses, mediastinal lymphadenopathy, and thickening of the wall of the gallbladder and abdominal aorta. Cytology and biopsy from the pancreaticobiliary tract was negative for malignancy. Serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA19-9) levels were in the normal range, but soluble interleukin 2 receptor (sIL2R), IgG4 and antinuclear antibody were abnormally high (sIL2R: 2,550 U/ml; IgG4: 764 mg/dl). Corticosteroid therapy was effective and these abnormal findings all improved. This case demonstrates the clinical importance of AIP accompanied by other systemic disorders in the differential diagnosis of patients with a pancreatic mass lesion.
Case Reports in Gastroenterology 05/2008; 2(2):155-61. DOI:10.1159/000125456
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