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Multicentric Italian survey on daily practice for autoimmune pancreatitis: Clinical data, diagnosis, treatment, and evolution toward pancreatic insufficiency

Authors :
Gemma Rossi
Guido Costamagna
Alberto Fantin
Raffaele Pezzilli
Luca Barresi
Gabriele Capurso
A. Garribba
Gianpiero Manes
Germana de Nucci
Elisabetta Buscarini
Matteo Tacelli
Ilenia Barbuscio
Silvia Carrara
L. Crocellà
Mario Traina
Endoscopists
Maria Francesca Dore
Stefano Francesco Crinò
Paolo Giorgio Arcidiacono
Guido Manfredi
Maria Chiara Petrone
Fabia Attili
Paoletta Preatoni
Luca Frulloni
Ilaria Tarantino
Nicolò de Pretis
Fabio Tuzzolino
Claudio De Angelis
Danilo Pagliari
Barresi, L.
Tacelli, M.
Crino, S. F.
Attili, F.
Petrone, M. C.
De Nucci, G.
Carrara, S.
Manfredi, G.
Capurso, G.
De Angelis, C. G.
Crocella, L.
Fantin, A.
Dore, M. F.
Garribba, A. T.
Tarantino, I.
De Pretis, N.
Pagliari, D.
Rossi, G.
Manes, G.
Preatoni, P.
Barbuscio, I.
Tuzzolino, F.
Traina, M.
Frulloni, L.
Costamagna, G.
Arcidiacono, P. G.
Buscarini, E.
Pezzilli, R.
Source :
United European Gastroenterol J
Publication Year :
2020
Publisher :
Wiley, 2020.

Abstract

BACKGROUND: Autoimmune pancreatitis (AIP) is a rare, and relatively new, form of chronic pancreatitis. The management of AIP can vary considerably among different centres in daily clinical practice. OBJECTIVES: The aim of this study is to present a picture of epidemiological, clinical characteristics, outcomes, and the real-life practice in terms of management in several academic and non-academic centres in Italy. METHODS: Data on the clinical presentation, diagnostic work-up, treatments, frequency of relapses, and long-term outcomes were retrospectively collected in a cohort of AIP patients diagnosed at 14 centres in Italy. RESULTS: One hundred and six patients were classified as type 1 AIP, 48 as type 2 AIP, and 19 as not otherwise specified. Epidemiological, clinical, radiological, and serological characteristics, and relapses were similar to those previously reported for different types of AIP. Endoscopic cytohistology was available in 46.2% of cases, and diagnostic for AIP in only 35.2%. Steroid trial to aid diagnosis was administered in 43.3% cases, and effective in 93.3%. Steroid therapy was used in 70.5% of cases, and effective in 92.6% of patients. Maintenance therapy with low dose of steroid (MST) was prescribed in 25.4% of cases at a mean dose of 5 (±1.4) mg/die, and median time of MST was 60 days. Immunosuppressive drugs were rarely used (10.9%), and rituximab in 1.7%. Faecal elastase-1 was evaluated in only 31.2% of patients, and was pathological in 59.2%. CONCLUSIONS: In this cohort of AIP patients, diagnosis and classification for subtype was frequently possible, confirming the different characteristics of AIP1 and AIP2 previously reported. Nevertheless, we observed a low use of histology and steroid trial for a diagnosis of AIP. Steroid treatment was the most used therapy in our cohort. Immunosuppressants and rituximab were rarely used. The evaluation of exocrine pancreatic insufficiency is underemployed considering its high prevalence.

Details

ISSN :
20506414 and 20506406
Volume :
8
Database :
OpenAIRE
Journal :
United European Gastroenterology Journal
Accession number :
edsair.doi.dedup.....598008c091197bf53e21038a10650426
Full Text :
https://doi.org/10.1177/2050640620924302