Abstract
AimTo characterize the clinical features of autoimmune pancreatitis (AIP) in China and compare differences between our Chinese cohort and Western cohorts.MethodsThis was a retrospective study of patients with AIP that was carried out in the China-Japan Friendship Hospital between January 2010 and April 2021. We included a total of 50 patients (46 males and 4 females) aged between 27 and 86 years who fulfilled the international Consensus Diagnostic (ICD) Criteria. For comparative purposes, we included data from seven representative Western cohorts.ResultWhen comparing Chinese and Western patients, we found that obstructive jaundice was the most frequent initial symptom (68 vs. 43%, P < 0.001). Extra-pancreatic organ involvement was more common in Chinese patients (68 vs. 30%, P < 0.001). Sclerosing cholangitis was the most frequent extrapancreatic lesion (48 vs. 24%, P = 0.001). The elevation of serum IgG4 was more obvious in our cohort (86 vs. 49%, P < 0.001). Conversely, the rates of ANA-positivity were significantly higher in Western populations (17 vs. 50%, P = 0.006). With regards to imaging, diffuse swelling was significantly more common in China (44 vs. 27%, P = 0.021). Steroid therapy was used more frequently in our Chinese patients (84 vs. 59%, P = 0.001). The steroid-response rate was also significantly higher in our Chinese patients (85 vs. 54%, P = 0.001); However, the rate of resection was higher in Western cohorts (2 vs. 31%, P < 0.001). There was no significant difference between the two populations with regards to recurrence rate (33 vs. 33%, P = 1.000).ConclusionThis study identified significant differences between Chinese and Western populations of patients with AIP. Within the Chinese population, AIP was more likely to have jaundice and extra-pancreatic organ involvement, and elevated serum IgG4 levels. Chinese patients were also showed favorable responses to treatment with glucocorticoids.
Highlights
In 1995, Yoshida et al [1] described a case of chronic pancreatitis with impaired pancreatic exocrine function and were the first to refer to this condition as autoimmune pancreatitis (AIP)
AIP is considered as a unique type of chronic pancreatitis that is mediated by autoimmunity and characterized by the infiltration of lymphocytes and plasma cells, diffuse enlargement of the pancreas, irregular changes in the pancreatic duct [2, 3], and elevated levels of serum immunoglobulin 4 (IgG4)(4), with or without the involvement of extra-pancreatic organs [5–14]
In 2011, the International Consensus Diagnostic Criteria (ICDC) for AIP was proposed; according to the ICDC, AIP was divided into type 1 AIP and type 2 AIP [17]
Summary
In 1995, Yoshida et al [1] described a case of chronic pancreatitis with impaired pancreatic exocrine function and were the first to refer to this condition as autoimmune pancreatitis (AIP). AIP is considered as a unique type of chronic pancreatitis that is mediated by autoimmunity and characterized by the infiltration of lymphocytes and plasma cells, diffuse enlargement of the pancreas, irregular changes in the pancreatic duct [2, 3], and elevated levels of serum immunoglobulin 4 (IgG4)(4), with or without the involvement of extra-pancreatic organs [5–14]. In 2003, pathologists in the United States and Europe reported another unique histological pattern that they referred to as idiopathic duct centric pancreatitis (IDCP) [15]; this condition was initially referred to as AIP with granulocyte epithelial lesions (GEL) [16] but is referred to as type 2 AIP. There have been far fewer systemic studies relating to Chinese patients with AIP. We compared phenotypic differences between our Chinese cohort and patients described in previous western cohorts [18–24]
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