Trattamento della pancreatite autoimmune con azatioprina.Risultati su una casistica personale con valutazione dei possibili effetti collaterali e dell associazione con le malattie infiamatorie croniche intestinali.

Autoimmune pancreatitis (AIP) is a particular form of inflammatory pancreatic disease that may involve diffusely or focally the pancreatic parenchyma. Pathologically, AIP has been classified in type 1 and type 2 disease. AIP may be associated with ulcerative colitis (UC) (20-30%) and this association is related to AIP type 2. About 30% of patients suffering from AIP experienced a clinical relapse of the disease, and relapses have been observed in AIP type 1. Non-steroidal immunosuppressant drugs has been suggested as treatment of relapsing AIP, but only reports with limited number of patients have been published up to now using azathioprine (AZA). AZA has been proposed in the treatment of AIP, despite AZA has been identified as a drug-inducing pancreatitis. The aim of this study has been to evaluate many aspects of this issue,particularly: 1. the efficacy of azathioprine in relapsing AIP; 2. the frequency of association between AIP and UC and differences in clinical, instrumental and outcome of AIP patients with and without UC; 3. histological findings of colon mucosa of AIP patients with suspected colon inflammation (inflammatory bowel disease – IBD) and distinctive features between AIP-IBD and IBD; 4. risk of pancreatitis in patients suffering from IBD treated with azathioprine. The main results of these investigations seems to allow the following conclusions: 1. the clinical and instrumental profile of AIP patients treated with AZA is different compared to those not-treated. The distinctive features found are the same of prognostic factors suggested in the literature. A subgroup of patients who may benefit from immunosuppressive treatment has been identify. 2. Ulcerative colitis is associated with AIP and AIP patients with IBD relapses as well as AIP patients without IBD and therefore can be treated with AZA. 3. The pathological features, including immunohistochemistry for IgG4+ plasmacells, of colon mucosa of AIP-IBD patients is similar to those suffering from IBD. 4. The results of systematic review indicate an increased risk of pancreatitis in IBD patients treated with AZA. However, the definition of pancreatitis in this study is far too low and does not allow any definitive conclusion.