Your body's defense system, the immune system, is like an army that protects a country. The job of this army is to identify and attack enemies like germs and viruses that come from outside, and save us from diseases. But, imagine what kind of destruction would happen if this army went a little wrong and started attacking the good people in our own country, thinking they were enemies? That's what happens in a disease called Autoimmune Pancreatitis (AIP). Here, our own defense system mistakenly thinks our own pancreas is an enemy and starts attacking it.
Simply put, what is Autoimmune Pancreatitis (AIP)?
This is a relatively rare condition. As we mentioned earlier, our immune system attacks our pancreas, causing chronic inflammation, or pancreatitis. It's only when this damage occurs over time that serious problems begin to arise. Often, we may not notice any symptoms until significant damage has occurred.
It can be difficult to diagnose this disease. This is because it is a rare disease, the symptoms are not always obvious, and even on scans, it can look like other diseases, especially pancreatic cancer . This can be scary for many people. But the best thing is that once you get diagnosed and start the right treatment, you can recover quickly .
There are two main types of Autoimmune Pancreatitis (AIP):
There are two main types of this disease. The way they affect our bodies is slightly different. Let's take a look at what they are.
| Feature | Type 1 (Type 1 AIP) | Type 2 (Type 2 AIP) |
|---|---|---|
| Other names | Also known as IgG4-related disease. | Also known as idiopathic duct-centric chronic pancreatitis (IDCP). |
| Affected organs | In addition to the pancreas, other organs such as the bile ducts, kidneys, liver, lungs, and salivary glands can also be affected. | It is often limited to the pancreas . |
| Blood tests | The level of IgG4 antibodies in the blood increases. | IgG4 levels do not usually increase. |
| Most common age | Usually after age 60. More common in men. | Usually occurs at a young age . It affects both sexes equally. |
| Other related diseases | May be associated with other autoimmune diseases. | About 30% of patients may also have a condition called inflammatory bowel disease (IBD) . |
| Relapse | There is a high chance of symptoms returning after treatment is stopped. | The chance of symptoms recurring is low . |
A little more about Type 1 AIP...
Simply put, this is one part of a larger group of diseases called IgG4-related diseases. IgG4 is a type of antibody that our body makes. In this disease, IgG4 and immune cells called plasma cells combine to travel through the tissues of the pancreas, causing inflammation and scarring.
A little more about Type 2 AIP...
In this type, IgG4 levels do not increase. And other organs are not affected. However, these people can sometimes develop recurrent episodes of acute pancreatitis. That is, the pancreas suddenly becomes inflamed and symptoms appear, which then subside after a few days.
What are the symptoms of this disease?
Although there may be no symptoms for a long time, the first sign that is often seen is painless jaundice . This is a very important sign. Some people may experience pain in the upper abdomen or back. This is because our pancreas is located between the stomach and the spine.
Imagine, there is a man about 65 years old. His eyes suddenly turned yellow, his body turned yellow. He has lost weight. But there is no major pain in his stomach. Anyone would be scared to see something like this. It is only when he goes to a doctor and does various tests that he discovers that this is not cancer, but Autoimmune Pancreatitis.
In addition, you can also see these symptoms:
- Dark urine and pale stools (fading to white)
- Fatigue
- Indigestion
- Loss of appetite and weight loss
- Nausea and vomiting
Why does this disease occur? What are the risk factors?
In fact, scientists still can't say 100% for sure why these autoimmune diseases develop. They believe it's a combination of both genes and environmental factors . For example, when our body gets a serious infection, our immune system can become overactive to fight it off. Sometimes, after the fight is over, the system can forget how to calm down and start attacking its own cells.
Also, someone who already has another autoimmune disease is slightly more likely to develop AIP. For example:
- Hashimoto's disease (a disease related to the thyroid gland)
- Ulcerative colitis (inflammation of the large intestine)
- Rheumatoid arthritis
- Sjögren's syndrome (a disease in which the salivary and tear glands dry out)
What are the possible complications of this disease?
Long-term inflammation can damage our organs. This leads to the formation of scar tissue. This scarring can impair the functioning of the pancreas. Then, our body stops producing the hormones and enzymes it needs, which can lead to digestive problems and diabetes.
There are two main complications that can be seen:
1. Biliary stricture: The bile ducts that carry bile, a fluid produced in our liver, to the intestines pass through the pancreas. When the pancreas becomes inflamed or scarred, these ducts can become blocked. Then, bile accumulates inside the body, causing jaundice.
2. Pancreatic cancer risk: This is the one that many people are afraid of. Autoimmune pancreatitis is not cancer. However, a person with chronic pancreatitis, for any reason, has a very small risk (about 1% - 2%) of developing pancreatic cancer. Since the symptoms of both diseases are similar, it is essential to distinguish between the two. That is why your doctor will look into this carefully.
How do doctors accurately diagnose this disease?
This is like a detective story. A single test cannot confirm the disease. It is also necessary to rule out other diseases, especially cancer. That is why the doctor will perform several tests.
| Test method | What is being done? |
|---|---|
| Blood tests | IgG4 antibody levels, liver and pancreatic enzyme levels are checked. Things like cancer markers can also be tested to see if there is a cancer condition. |
| Imaging tests | MRI or CT scans look for swelling or scarring in the pancreas and other organs. A special MRI scan called MRCP looks closely at the bile ducts and pancreatic duct system. |
| Biopsy | Endoscopic Ultrasound, a method in which a small piece of tissue is taken from the pancreas using an endoscope and examined under a microscope, is 100% accurate in diagnosing the disease. |
| Treatment trial | In some cases, the doctor will start the medication used for AIP (corticosteroids) and see if the symptoms improve. If the symptoms improve quickly, that is also evidence to support the diagnosis. |
What are the treatments?
The main and most effective treatment for autoimmune pancreatitis is a class of drugs called corticosteroids . Prednisone is the most commonly used drug. These drugs work by calming our overactive immune system and reducing inflammation.
Treatment usually starts with a high dose of the drug . As your symptoms and test results improve, your doctor will gradually reduce the dose. Sometimes, after you stop taking steroids, you may be given other immunosuppressant medications to help control the disease.
If there are complications, such as bile duct obstruction, this will need to be treated separately. For example, a stent may be placed to open the blocked duct. Very rarely, surgery may be required.
What will life be like with this disease?
The good news is that autoimmune pancreatitis is a very treatable disease . You can see a significant improvement in your symptoms within a few weeks of starting steroid treatment. Many people are able to stop taking the medication completely over time.
However, sometimes (especially in Type 1 AIP) symptoms may return (relapse) after stopping treatment. In such cases, you may need to continue taking the medication at a lower dose. Your doctor will continue to monitor your condition and develop a treatment plan that is best for you.
This can be a somewhat insidious disease. Symptoms can go undetected for years, and when symptoms do appear, they can be confusing. So it can take a while to get an accurate diagnosis. However, remember that there are very effective treatments for this disease, and with treatment, you can recover quickly. That will give you great strength.
Take-Home Message
- Autoimmune Pancreatitis (AIP) is a disease caused by our own immune system attacking our pancreas.
- Painless jaundice and unexplained weight loss may be the main symptoms.
- Although it may look like pancreatic cancer on scans, AIP is not cancer. It is essential to differentiate the two through proper testing.
- This disease responds very well to treatment with corticosteroids and can be cured quickly.
- If you have these symptoms, don't panic and see your doctor as soon as possible for advice.
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