Assessing Idiopathic Duct-Centric Chronic Pancreatitis
Idiopathic duct-centric chronic pancreatitis (IDCP), also known as type 2 autoimmune pancreatitis (AIP), is an uncommon subtype of AIP. According to International Consensus Diagnostic Criteria, diagnosis of IDCP requires pancreatic histology and/or concurrent inflammable bowel disease (IBD).
In a recent study published in the journal Gut, Mayo Clinic researchers, first author Suresh Chari, M.D., examined past experience with IDCP (type 2 AIP) to assess the appropriateness of the International Consensus Diagnostic Criteria, and identify unique characteristics in patients presenting with acute pancreatitis.
Researchers reviewed the Mayo Clinic AIP database through May 2014 to identify subjects with either definitive or probable IDCP. They compared demographic and clinical factors based on strength of diagnostic confidence, presence of IBD, and acute pancreatitis as the presenting manifestation. Relapse-free survival was determined using the Kaplan-Meier method.
Common clinical presentations included acute pancreatitis and pancreatic mass/obstructive jaundice. The cumulative relapse rate was 10.6 percent at three years. Relapse-free survival was similar for the different diagnostic categories, but was decreased in those initially presenting with acute pancreatitis or treated with steroids.
Based on these results, the current diagnostic classification of probable IDCP and the inclusion of IBD as a supportive criterion appear valid because patients have similar clinical profiles and disease-related outcomes to those with definitive IDCP. Concurrent IBD, especially in young patients, may suggest when IDCP is the underlying cause of recurrent acute pancreatitis. However, additional studies are needed for validation.