論文

査読有り
2014年6月

Amendment of the Japanese Consensus Guidelines for Autoimmune Pancreatitis, 2013 III. Treatment and prognosis of autoimmune pancreatitis

JOURNAL OF GASTROENTEROLOGY
  • Terumi Kamisawa
  • Kazuichi Okazaki
  • Shigeyuki Kawa
  • Tetsuhide Ito
  • Kazuo Inui
  • Hiroyuki Irie
  • Takayoshi Nishino
  • Kenji Notohara
  • Isao Nishimori
  • Shigeki Tanaka
  • Toshimasa Nishiyama
  • Koichi Suda
  • Keiko Shiratori
  • Masao Tanaka
  • Tooru Shimosegawa
  • 全て表示

49
6
開始ページ
961
終了ページ
970
記述言語
英語
掲載種別
研究論文(学術雑誌)
DOI
10.1007/s00535-014-0945-z
出版者・発行元
SPRINGER JAPAN KK

The standard treatment for autoimmune pancreatitis (AIP) is steroid therapy, although some patients improve spontaneously. Indications for steroid therapy in AIP patients are symptoms such as obstructive jaundice, abdominal pain, back pain, and the presence of symptomatic extrapancreatic lesions. Prior to steroid therapy, obstructive jaundice should be managed by biliary drainage, and blood glucose levels should be controlled in patients with diabetes mellitus. The recommended initial oral prednisolone dose for induction of remission is 0.6 mg/kg/day, which is administered for 2-4 weeks. The dose is then tapered by 5 mg every 1-2 weeks, based on changes in clinical manifestations, biochemical blood tests (such as liver enzymes and IgG or IgG4 levels), and repeated imaging findings (US, CT, MRCP, ERCP, etc.). The dose is tapered to a maintenance dose (2.5-5 mg/day) over a period of 2-3 months. Cessation of steroid therapy should be based on the disease activity in each case. Termination of maintenance therapy should be planned within 3 years in cases with radiological and serological improvement. Re-administration or dose-up of steroid is effective for treating AIP relapse. Application of immunomodulatory drugs is considered for AIP patients who prove resistant to steroid therapy. The prognosis of AIP appears to be good over the short-term with steroid therapy. The long-term outcome is less clear, as there are many unknown factors, such as relapse, pancreatic exocrine or endocrine dysfunction, and associated malignancy.

リンク情報
DOI
https://doi.org/10.1007/s00535-014-0945-z
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/24639058
Web of Science
https://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=JSTA_CEL&SrcApp=J_Gate_JST&DestLinkType=FullRecord&KeyUT=WOS:000337031600001&DestApp=WOS_CPL
ID情報
  • DOI : 10.1007/s00535-014-0945-z
  • ISSN : 0944-1174
  • eISSN : 1435-5922
  • PubMed ID : 24639058
  • Web of Science ID : WOS:000337031600001

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