Home > Gastroenterology > Autoimmune Pancreatitis
Serum Immunoglobulin G4 (IgG4) - levels greater than 140 mg/DL has a sensitivity of 76% and specificity of 93%.
Endoscopic ultrasound with biopsy. Early imaging usually shows diffusely enlarged pancreas; this can appear like a tumor.
Prednisone 30 to 40 mg PO qday for 4 to 8 weeks. Taper 5 mg per week.
Consider azathioprine 2-2.5 mg/kg/day or mycophenolate mofetil 750 mg twice daily if there is no response to prednisone (2).
Normalization of IgG4 could take several months. 30-40% have relapse, requiring repeat course and maintenance dose of 5 to 10 mg PO qday.
Consider H. pylori testing since the antibodies react to H. pylori.
IGG4 Systemic Disease
Pathology: lymphoplasmacytic infiltrates, IgG4-positive plasma cells and fibrosis (4).
Progression: Cirrhosis, portal hypertension, aortic aneurysm and dissection, salivary and lacrimal gland dysfunction, fibrosis of thyroid gland (2).
Please consider an official gastroenterology consult and refer to the sources below.