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Published on: March 23, 2018
Autoimmune markers in children with chronic pancreatitis
Grzegorz Oracz1, Bożena Cukrowska2, Jarosław Kierkuś1
1Department of Gastroenterology, Hepatology and Feeding Disorders, The Children's Memorial Health Institute, Warsaw, Poland.
Insights
Autoimmune markers are common in children with chronic pancreatitis (CP), suggesting autoimmune pancreatitis (AIP) may play a role. Further research is needed to understand its impact on disease severity and clinical course.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Autoimmune Diseases
Background:
- Autoimmune diseases are increasing, including in children.
- Chronic pancreatitis (CP) in children has varied causes, but the role of autoimmune pancreatitis (AIP) is not well understood.
- Paediatric experience with CP and AIP is limited.
Purpose of the Study:
- To determine the frequency of autoimmune markers in children diagnosed with CP.
- To investigate the potential role of autoimmune pancreatitis (AIP) in paediatric chronic pancreatitis.
Main Methods:
- Examined 129 children with CP for AIP markers between 2005-2012.
- Measured IgG4 levels and tested for various anti-tissue antibodies (ANA, ASMA, AMA, ANCA, AHA).
- Analyzed clinical data and correlated findings with genetic mutations and anatomical anomalies.
Main Results:
- Autoimmune markers were found in 58% (75/129) of children.
- Elevated IgG4 levels were observed in 35.3% (24/68) of patients.
- AIP was suspected in 4.6% (6/129) of cases; autoimmune markers were associated with genetic mutations (42.6%) and anatomical anomalies (21.3%) but not disease severity.
Conclusions:
- Children with CP exhibit a high prevalence of biochemical autoimmune markers, similar to adults.
- Autoimmune pancreatitis (AIP) should be considered in the differential diagnosis of chronic pancreatitis in children.
- The presence of autoimmune markers did not significantly alter disease severity or clinical course in this paediatric cohort.
Introduction:
In the last decade we can observe a gradual increase in the incidence of autoimmune diseases. The aetiology of chronic pancreatitis (CP) in children is varied and includes gene mutations, anatomic anomalies and others. The reported paediatric experience with chronic CP is scarce and little is known about the role of autoimmune pancreatitis (AIP).
Aim:
To assess the frequency of autoimmune markers in children with CP.
Material And Methods:
One hundred and twenty-nine children hospitalised between 2005 and 2012 at the Department of Gastroenterology, The Children's Memorial Health Institute, were examined for the presence of AIP; the level of IgG4 was determined, and tests for anti-tissue antibodies (ANA, ASMA, AMA, ANCA, AHA) were conducted. Clinical data were recorded and analysed.
Results:
Anti-tissue antibodies were detected in 75/129 children (58%), and 24/68 patients (35.3%) showed an increased IgG4 level. Based on the International Association of Pancreatology criteria, a suspicion of AIP was raised in 6 patients (4.6%). We found gene mutations predisposing to CP in 32/75 (42.6%) patients with autoimmune markers. In 16/75 children (21.3%), anatomic anomalies were found. There was no difference in the severity of the disease and clinical course between children with evidence of autoimmune process and patients without autoimmune markers (p = NS).
Conclusions:
In children with CP, similarly to adults, there is a high frequency of biochemical markers of autoimmunity. It is worth remembering that AIP can occur in children.
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