Autoimmune pancreatitis and IgG-positive sclerosing cholangitis

Czech version

Authors: Petr Dítě ¹; I. Novotný ²; J. Lata ³; M. Růžička ⁴; E. Geryk ¹; Bohuslav Kianička ⁵
Authors‘ workplace: Lékařská fakulta MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Aleš Hep, CSc. ¹; Masarykův onkologický ústav Brno, ředitel prof. MUDr. Jiří Vorlíček, CSc. ²; Lékařská fakulta Ostravské univerzity Ostrava, děkan doc. MUDr. Arnošt Martínek, CSc. ³; Sheikh Khalifa Med. City – Cleveland Clinic, Abu Dhabi, U. A. E. ⁴; Gastroenterologické oddělení II. interní klinika Lékařské fakulty MU a FN u sv. Anny Brno, přednosta prof. MUDr. Miroslav Souček, CSc. ⁵
Published in: Vnitř Lék 2011; 57(3): 254-257
Category: 60th birthday of prof. Mudr. Jiřího Vítovce, CSc, FESC

Overview

Sclerosing cholangitis is a heterogenous disease. Sclerosing cholangitis with an unknown cause is abbreviated PSC. PSC affects extra- as well as intra-hepatic bile ducts and since this is a permanently progressing fibrous condition, it leads to liver cirrhosis. The disease is often associated with a development of cholangocarcinoma and idiopathic intestinal inflammation. Causal therapy does not exist; liver transplantation is indicated. IgG4 cholangitis differs from PSC in a number of features. This form is, unlike PSC, linked to autoimmune pancreatitis (AIP) as well as other IgG4 sclerosing diseases. Anatomically, distal region of ductus choledochus is most frequently involved. Icterus is, unlike in PSC, a frequent symptom of AIP. There also is a distinctive histological picture – significant lymphoplasmatic infiltration of the bile duct wall with abundance of IgG4 has been described, lymphoplasmatic infiltration with fibrosis in the periportal area and the presence of obliterating phlebitis is also typical. However, intact biliary epithelium is a typical feature. IgG4 can be diagnosed even without concurrent presence of AIP. IgG4 sclerosing cholangitis is a condition sensitive to steroid therapy. At present, there is no doubt that IgG4 sclerosing cholangitis is a completely different condition to primary sclerosing cholangitis. From the clinical perspective, these diseases should be differentiated in every clinician’s mind as (a) AIP is treated with corticosteroids and not with an unnecessary surgery, (b) IgG4 sclerosing cholangitis is mostly successfully treated with corticosteroids and the disease is not, unlike PSC, a risk factor for the development of cholangiocarcinoma.

Key words:
autoimmune pancreatitis – IgG4 sclerosing cholangitis – IgG4-Related Sclerosing Disease

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