Introduction
Autoimmune pancreatic refers to chronic pancreatic inflammation due to autoimmune manifestations. It was first described by Yoshida et al. in 1995. This type of pancreatitis represents a system autoimmune condition involving other organs, such as the bile duct, lymph nodes, and the retroperitoneum depending on the specific tissue changes observed in a biopsy.
Autoimmune pancreatitis can be named as:
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Idiopathic duct destructive pancreatitis.
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Lymphoplasmacytic sclerosing pancreatitis with cholangitis
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Primary inflammatory pancreatitis.
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Tumefactive pancreatitis.
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Non-alcoholic duct destructive chronic pancreatitis.
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Destructive pancreatitis.
What Is the Difference Between Pancreatitis and Autoimmune Pancreatitis?
Pancreatitis is the inflammation of the pancreas. In comparison, autoimmune pancreatitis is a type of pancreatitis. It is an immunity-mediated condition in which the body's immune system causes inflammation of the pancreas.
What Are the Three Types of Pancreatitis?
The three types of pancreatitis are:
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Acute Pancreatitis: Inflammation of the pancreas with sudden onset and resolves within a few days. This type of inflammation may not even require antibiotics, pain medications, or intravenous fluid supplies.
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Chronic Pancreatitis: The onset of symptoms is slow and lasts longer than acute pancreatitis. The patient may need a long hospital stage with pain medication and intravenous hydration.
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Hereditary: Inflammatory pancreas disorders inherited from one generation to another generation. Diagnosis is made depending on medical and family history.
What Are the Types of Autoimmune Pancreatitis?
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Type 1 Autoimmune Pancreatitis: This is an IgG4 - related disease which can affect multiple organs along with the pancreas, such as bile ducts, liver, kidneys, salivary glands, and lymph nodes.
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Type 2 Autoimmune Pancreatitis: This type of autoimmune pancreatitis affects only the pancreas, and in the majority of cases, it is associated with inflammatory bowel disease.
What Are Early Signs of Pancreas Problems?
The early signs of pancreatitis:
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Nausea.
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Vomiting.
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Upper abdominal pain.
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Tenderness when touching the abdomen.
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Abdominal pain that radiates to your back.
Symptoms of Autoimmune Pancreatitis:
Autoimmune pancreatitis is known to show no symptoms. However, the signs of pancreatic cancer resemble autoimmune pancreatitis.
These symptoms include:
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Yellowish discoloration of eyes and skin (jaundice).
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Pain in the upper abdomen or at the center of the back.
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Dark-colored urine.
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Nausea and vomiting.
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Energy loss and extreme tiredness.
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Loss of appetite and weight loss.
What Is the Cause of Autoimmune Pancreatitis?
The cause of autoimmune pancreatitis is autoimmune; various immune-mediated mechanisms can trigger the inflammatory response. T-cells mediated immune reaction and shifted to the peripheral blood T- lymphocytes towards T-helper 2 response could also contribute to the recruitment of interleukins and cytokines, inducing inflammation and fibrosis. The IgG4 antibodies are tissue-destructive immunoglobulins in both local and systemic functions.
How to Diagnose Autoimmune Pancreatitis?
The evolution of autoimmune pancreatitis includes imaging of the pancreas and pancreatic duct.
Imaging techniques used are,
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Magnetic resonance imaging (MRI) shows a diffuse enlargement of the pancreas.
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Computed Tomography (CT) demonstrates a diffuse or focal enlargement of the pancreas with ill-defined pancreatic clefts. The diffusion makes the pancreas look ‘sausage-shaped.’
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MRI with cholangiopancreatogram (MRCP) is done to evaluate the size, texture, contrast, and presence of strictures.
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Other tests, along with imaging, include a comprehensive metabolic panel, complete blood count, and liver and kidney function tests.
Does Pancreatitis Always Show Up on a Computed Tomography?
Computed Tomography is almost 60 % to 95 % sensitive in diagnosing advanced disorders and infections because it can readily detect parenchymal changes associated with inflammation such as pancreatitis.
What Is the Treatment of Autoimmune Pancreatitis?
Administration of corticosteroids leads to improvement in symptoms as well as reducing complications. However, in almost half of the cases, there can be a relapse of autoimmune pancreatitis or failure of steroid treatment. Azathioprine is seen to be effective. Patients with biliary strictures also show a high risk of relapse after withdrawal from steroid therapy.
What to Eat in Cases of Autoimmune Pancreatitis?
To keep the pancreas healthy, it is important to focus on a protein-rich diet along with low animal fat concentrations and is rich in antioxidants. Food items such as beans, lean meats, soups, and dairy alternatives should be consumed. Artificial sweets should be replaced with fruits, as cases of pancreatitis are a higher risk of developing diabetes. Food items such as blueberries, spinach, cherries, and whole grains should be added to the diet to facilitate digestion. Pancreatitis can cause fluid loss. Thus it is important to consume lots of water and fluids.
What Is the Management of Autoimmune Pancreatitis?
1. Dietary Recommendations and changes:
A low-fat diet is often advised to reduce stress on the pancreas. Avoiding fried foods, processed sugars, and excessive red meat consumption can be beneficial. Reduce intake of high-fat foods as they can exacerbate symptoms. Focus on lean proteins, whole grains, fruits, and vegetables. Steer clear of fried foods and processed sugars. Eating smaller, more frequent meals can ease the burden on the pancreas compared to large meals. Staying well-hydrated is important. Water is usually the best choice; however, consult with your healthcare provider if there are specific hydration needs. Limit Alcohol and Caffeine Both can irritate the pancreas. Reducing or eliminating alcohol and moderating caffeine intake might be recommended. Sometimes, deficiencies in certain vitamins (like fat-soluble vitamins A, D, E, and K) can occur due to malabsorption.
2. Importance of Physical Activity and Stress Management:
Regular exercise not only helps maintain a healthy weight but also supports overall well-being. Stress can exacerbate symptoms, so incorporating stress-reduction techniques like meditation, yoga, or mindfulness can be immensely helpful.
3. Avoiding Smoking and Excessive Alcohol:
Both smoking and excessive alcohol can worsen pancreatic health. Steering clear of these substances is crucial in managing AIP.
4. Regular Check-ups and Blood Sugar Monitoring:
Consistent monitoring of blood sugar levels is essential, as pancreatitis can affect insulin production. Routine check-ups with healthcare professionals help track your progress and catch any potential issues early.
5. Support Groups and Resources:
Joining support groups or seeking out resources specific to AIP can provide a sense of community and valuable information. Connecting with others facing similar challenges can be emotionally supportive and educational.
Which Diseases Are Similar to Autoimmune Pancreatitis?
The most similar disease to autoimmune pancreatitis is pancreatic cancer. However, the clinical findings and imaging of the two are very difficult to differentiate. However, the histopathologic examination helps differentiate between the two inflammation and malignancies.
Other diseases which are similar to autoimmune pancreatitis are:
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Choledocholithiasis: Presence of a minimum of one gallstone in the bile duct. The gallstone can be cholesterol salts, bile pigments, and calcium.
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Pancreatic Cyst: Overgrowth of pancreatic tissue on its wall. It is benign in nature.
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Cholangiocarcinoma: Malignancy in the bile duct helps to carry digestive fluid bile.
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Scarring of Pancreas: Recurrent inflammation and infection can lead to the formation of scars and loss of function.
Conclusion:
Autoimmune pancreatitis is inflammation of the pancreas due to immune-mediated responses. It can be of two types depending on the organs affected. Type 1 affects organs like the bile duct, kidneys, salivary glands, and pancreas. Whereas type 2 affects only the pancreas. Autoimmune pancreatitis symptoms include abdominal pain, pallor, loss of appetite, and weakness. The treatment of choice is steroid therapy in the majority of cases. It is important to focus on a protein-rich diet along with low animal fat concentrations and rich in antioxidants to keep the pancreas healthy. Food items like beans, lean meats, soups, and dairy alternatives should be consumed. Also, blueberries, spinach, cherries, and whole grains should be added to the diet to facilitate digestion.
