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Presentation and Management of Post-treatment Relapse in Autoimmune Pancreatitis/Immunoglobulin G4-Associated Cholangitis  Neomal S. Sandanayake, Nicholas.

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Presentation on theme: "Presentation and Management of Post-treatment Relapse in Autoimmune Pancreatitis/Immunoglobulin G4-Associated Cholangitis  Neomal S. Sandanayake, Nicholas."— Presentation transcript:

1 Presentation and Management of Post-treatment Relapse in Autoimmune Pancreatitis/Immunoglobulin G4-Associated Cholangitis  Neomal S. Sandanayake, Nicholas I. Church, Michael H. Chapman, Gavin J. Johnson, Dipok K. Dhar, Zahir Amin, Maesha G. Deheragoda, Marco Novelli, Alison Winstanley, Manuel Rodriguez–Justo, Adrian R.W. Hatfield, Stephen P. Pereira, George J.M. Webster  Clinical Gastroenterology and Hepatology  Volume 7, Issue 10, Pages (October 2009) DOI: /j.cgh Copyright © 2009 AGA Institute Terms and Conditions

2 Figure 1 Response and outcome to treatment. *Recent relapse; **low-dose steroids for polyarthritis. Clinical Gastroenterology and Hepatology 2009 7, DOI: ( /j.cgh ) Copyright © 2009 AGA Institute Terms and Conditions

3 Figure 2 Disease relapse and response to treatment in AIP/IAC. Sequential MRCP scans of patient 10. (A) Taken at diagnosis, a complex hilar stricture with subsegmental intrahepatic strictures caused by obstruction at hilum (arrow) is shown. After an excellent clinical response to 9 months of steroids, marked improvement is seen in biliary stricturing at 18 months (B). Note dilated pancreatic duct and features of chronic pancreatitis (thick arrow). Ten months later (C) patient presented with fatigue, biliary obstruction, and elevated serum IgG4 level. After reintroduction of steroids and AZA, marked improvement of biliary stricturing again is seen (D). Clinical Gastroenterology and Hepatology 2009 7, DOI: ( /j.cgh ) Copyright © 2009 AGA Institute Terms and Conditions

4 Figure 3 Serum IgG4 before and after treatment. Box and whisker plot of serum IgG4 in pretreatment cohort, after treatment in the relapse/failure to wean steroid group, and the nonrelapse groups. ULN, upper limit of normal (1.3 g/L). Clinical Gastroenterology and Hepatology 2009 7, DOI: ( /j.cgh ) Copyright © 2009 AGA Institute Terms and Conditions


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