Differentiation of autoimmune pancreatitis from pancreas cancer: utility of anti-amylase and anti-carbonic anhydrase II autoantibodies.

PURPOSE: To investigate the utility of different combinations of serum anti-carbonic anhydrase II antibodies (CA II Abs), anti-α amylase antibodies (AMY-α Abs) and IgG4 levels for the diagnosis of autoimmune pancreatitis (AIP). METHODS: We recruited 93 patients with clinical suspicion for AIP and 94 patients as control groups between June 2003 and October 2009. Serum antibodies were measured using homemade enzyme linked immunosorbent assay and IgG4 levels were determined by nephelometry. RESULTS: Both CA-II Abs and AMY-α Abs had the highest sensitivity (83%) although AMY-α Abs (89%) were more specific than CA-II Abs (75%). The presence of increased IgG4 levels was the most specific serological marker (94%), but it had the lowest sensitivity (58%). The combination of the three serological markers altogether had the highest specificity (99%) and positive predictive value (PPV) (86%), but they had a rather low sensitivity (50%). When we combined CA-II Abs and AMY-α Abs without IgG4 levels, we got the highest sensitivity (75%) and negative predictive value (98%) but the specificity and the PPV decreased to 93 and 50%, respectively. Importantly, AMY-α Abs were not detected in pancreas cancer. CONCLUSIONS: The presence of serum CA-II and AMY-α Abs with increased IgG4 is useful in the differential diagnosis of AIP from pancreatic cancer.

[Autoimmune pancreatitis. An infrequent or underdiagnosed entity? Pathological, clinical and immunological characteristics]. / Pancreatitis autoinmune. 'Una entidad poco frecuente o infradiagnosticada? Características anatomopatológicas, clínicas e inmunológicas.

In the last few years, reports of pancreatic inflammatory diseases caused by immunological mechanisms and with good response to steroid treatment have increased. Although this entity has been known by a number of names, at present the most widely accepted is that of autoimmune chronic pancreatitis (ACP). The present report describes the clinical, immunological, morphological, functional and pathological characteristics of two patients recently studied at our unit and discusses currently used diagnostic tests. The two patients had a complete response to steroid therapy. In our opinion, ACP is probably underdiagnosed in Spain. The availability of morphological, pathological and serological diagnostic tools developed in recent years will help to precisely determine the epidemiology of this process. Thus, quantification of serum levels of anti-carbonic anhydrase II and IgG4 has greatly contributed to the diagnosis of ACP. These tests should be performed in patients with a possible diagnosis of ACP, those suffering from diabetes mellitus type I with impairment of exocrine function, and those with alcoholic pancreatitis and a poor response to alcohol elimination. Once we are able to diagnose and determine the real prevalence of ACP in our setting, the most appropriate therapy and prognosis of this disease can be established.

Use of antioxidants to treat pain in chronic pancreatitis.

OBJECTIVE: The purpose of this report is to analyze the results of a 1-year clinical study of antioxidant therapy in the treatment of pain and recurrent inflammatory episodes in patients with chronic and acute recurrent pancreatitis, using a prospective, descriptive, pre-post, open design. The intensity of pain at the beginning and end of treatment was assessed with a visual analogue scale, and these results along with the number of hospital admissions for pancreatic disease were analyzed. METHODS: We studied patients with acute recurrent or chronic pancreatitis who had suffered from pain or acute inflammatory episodes the year before the beginning of treatment with a complex containing L-methionine, beta-carotene, vitamin C, vitamin E and organic selenium. RESULTS: Of 10 patients with chronic pancreatitis who completed treatment, the intensity of pain was reduced considerably in 9 (61.5 +/- 21.5 mm vs. 19.6 +/- 26.1 mm, p = 0.03), and pain was completely absent in 3 of these patients. Twelve patients who completed treatment had fewer hospital admissions during the year with antioxidant treatment than they had had during the previous year (1.5 +/- 1.62 vs. 0.25 +/- 0.45 admissions, p = 0.03). CONCLUSIONS: Antioxidant treatment had a positive effect in patients who suffered from pancreatic inflammatory pain, and its effectiveness should be tested before more aggressive and costlier treatments are considered.

Relationship between the presenting symptoms and age at diagnosis in alcoholic and nonalcoholic chronic pancreatitis: analysis of 164 patients.

OBJECTIVE: To study the different forms of presentation, patient age, delay in diagnosis and incidence of calculi in alcoholic and nonalcoholic chronic pancreatitis. METHODS: We have studied 130 men and 34 women diagnosed as having chronic pancreatitis on the basis of clinical criteria and morphological and/or functional tests. RESULTS: Alcohol was the most common cause of chronic pancreatitis in men (89.1%) existing a significant difference with respect to women (p < 0.05). The mean age of the patients with alcoholic chronic pancreatitis was 45.6 +/- 11.3 years and that of patients presenting nonalcoholic chronic pancreatitis was 54.5 +/- 11.5 years (p < 0.01), the latter showing a bimodal distribution. The ages of the patients in whom the presenting symptom was abdominal pain and acute inflammatory episodes were 43.9 +/- 12.8 and 45.3 +/- 13.5 years, respectively, significantly lower (p < 0.05) than the age of patients in whom presentation was signaled by the onset of diabetes or diarrhea (53.1 +/- 11.2 and 61.2 +/- 12.9 years, respectively). Statistically significant differences existed in the delay in diagnosis when comparing the patients before and after 1985 (12.3 +/- 14.5 years, range 0 to 50 years, versus 0.42 +/- 0.9 years, range 0 to 5 years; p = 0.005). At diagnosis, 14.3% of the patients whose presenting symptom was acute pancreatitis had pancreatic calculi, versus 42.2% of those who reported abdominal pain as the first indication. CONCLUSIONS: Alcoholic chronic pancreatitis predominates in men. Nonalcoholic chronic pancreatitis presents two peaks of prevalence. A substantial number of patients may remain pain-free up to diagnosis. Calculi are not uncommon during the initial period of chronic pancreatitis when pain is the presenting symptom, either in the form of isolated episodes of abdominal pain or attacks of acute pancreatitis.

Small bowel bacterial overgrowth in patients with alcoholic cirrhosis.

A total of 89 patients with alcoholic cirrhosis and 40 healthy subjects were included in a study to assess the prevalence of intestinal bacterial overgrowth and to analyze its relationship with the severity of liver dysfunction, presence of ascites, and development of spontaneous bacterial peritonitis (SBP). Bacterial overgrowth was measured by means of a breath test after ingestion of glucose. Intestinal bacterial overgrowth was documented in 27 (30.3%) of the 89 patients with alcoholic cirrhosis and in none of the healthy subjects. The prevalence of intestinal bacterial overgrowth was significantly higher in cirrhotics with ascites (37.1%) than in those with no evidence of ascites (5.3%) and among patients with Pugh-Child class C (48.3%) than in patients with a class A (13.1%) or B (27%). Twelve (17.1%) of the 70 patients with ascites developed an episode of SBP. The prevalence of spontaneous bacterial peritonitis was significantly higher in patients who had intestinal bacterial overgrowth (30.7%) than in patients who did not (9.09%). We conclude that intestinal bacterial overgrowth occurs in approximately one third of patients with cirrhosis secondary to alcohol, particularly in patients with ascites and advanced liver dysfunction. Moreover, bacterial overgrowth may be a condition favoring infection of the ascitic fluid.

Small bowel bacterial overgrowth in patients with alcoholic cirrhosis.

A total of 89 patients with alcoholic cirrhosis and 40 healthy subjects were included in a study to assess the prevalence of intestinal bacterial overgrowth and to analyze its relationship with the severity of liver dysfunction, presence of ascites, and development of spontaneous bacterial peritonitis (SBP). Bacterial overgrowth was measured by means of a breath test after ingestion of glucose. Intestinal bacterial overgrowth was documented in 27 (30.3%) of the 89 patients with alcoholic cirrhosis and in none of the healthy subjects. The prevalence of intestinal bacterial overgrowth was significantly higher in cirrhotics with ascites (37.1%) than in those with no evidence of ascites (5.3%) and among patients with Pugh-Child class C (48.3%) than in patients with class A (13.1%) or B (27%). Twelve (17.1%) of the 70 patients with ascites developed an episode of SBP. The prevalence of spontaneous bacterial peritonitis was significantly higher in patients who had intestinal bacterial overgrowth (30.7%) than in patients who did not (9.09%). We conclude that intestinal bacterial overgrowth occurs in approximately one third of patients with cirrhosis secondary to alcohol, particularly in patients with ascites and advanced liver dysfunction. Moreover, bacterial overgrowth may be a condition favoring infection of the ascitic fluid.

[Cell-mediated and humoral immunity in ulcerative colitis. Acute phase reactants (author's transl)]. / Inmunidad celular y humoral en colitis ulcerosa. Reactantes de fase aguda.

Many findings suggest that the alterations in immune response observed in intestinal inflammatory diseases may play a part in their pathogenesis. This observation led us to study 22 patients with chronic ulcerative colitis, of whom seven were in the acute stage and the other 15 were asymptomatic. The T and B lymphocyte populations were determined as well as the serum levels of immunoglobulins and acid alpha-1-glycoprotein as acute phase reactants. The results were compared with those obtained from a control group of 10 normal individuals. No statistically significant differences were observed in the percentages and absolute values of T and B lymphocytes as compared with the controls. nor in relation to the activity of the lesions. Neither were there any observable variations in the serum concentrations of immunoglobulins. On the other hand, analysis of the acid alpha-1-glycoprotein showed highly significant values as related to the degree of activity of the inflammatory lesion (p less than 0.005). Our results confirmed the value of determining serum acid alpha-1-glycoprotein levels as an index of inflammatory activity. The immunitary parameters under study did not vary in the different stages of the disease.