Is your body's own defense system playing tricks on you? Let's learn about Autoimmune Pancreatitis in a simple way!

We have an amazing defense system in our bodies, don't we? That's what we call the immune system. It protects us by fighting off germs, bacteria, and viruses that cause disease. But imagine, what if sometimes this very defense system of ours gets confused with the good cells in our own body and starts attacking them? That's when it happens, called ``Autoimmune Pancreatitis''. Simply put, your own immune system starts working against your pancreas.

What is ``Autoimmune Pancreatitis''? Simply put...

Think of your body's immune system as an army that protects a country. The job of this army is to protect the country from external enemies (such as germs and viruses). But in `(Autoimmune Pancreatitis)`, this army makes a mistake and attacks innocent citizens of its own country (that is, healthy cells in the pancreas) thinking that they are enemies. As a result, the pancreas becomes inflamed, injured, and its function is impaired. This is what we call autoimmune pancreatitis .

How common is this disease?

Actually, `(Autoimmune Pancreatitis)` is a rather rare disease . It usually occurs in about one in a hundred thousand people. If we take long-term inflammatory conditions of the pancreas (`chronic pancreatitis`), only about 2% of them fall into this `(Autoimmune Pancreatitis)` category. So, this is not a disease that affects everyone.

Are there types of `(Autoimmune Pancreatitis)`?

Yes, there are mainly two types of `(Autoimmune Pancreatitis)`. Let's see what they are.

1. Type 1 Autoimmune Pancreatitis

This is the most common type . In this, we have more of a protein called `(Immunoglobulin G4)` or `(IgG4)` in our body. This `(IgG4)` is a type of antibody. When there is swelling or inflammation anywhere in the body, the level of this `(IgG4)` increases.

But in this first type, the problem is not only with the pancreas. It can also affect other organs in our body. For example:

• Bile ducts: These are tube -like tubes that carry bile from the liver to the small intestine.
• Renal tubes: The tubes in the kidneys.
• Liver
• Lungs
• Gallbladder
• Salivary glands
• Thyroid gland

Swelling and damage can also occur in places like these.

2. Type 2 Autoimmune Pancreatitis

This type only affects the pancreas . What happens here is that a type of white blood cell called ``neutrophils`` damage the pancreas and pancreatic ducts. This condition is most often seen in younger people.They are also more likely to have inflammatory bowel disease (IBD).

What are the causes of `(Autoimmune Pancreatitis)`? Are there any risk factors?

Researchers are still trying to figure out the exact cause , but it usually occurs in people between the ages of 50 and 60. However, it can occur earlier. Men are twice as likely to develop the disease as women.

Sometimes, it is thought to be a reaction of the body's immune system to a bacterial infection. In addition, people with other autoimmune disorders are at higher risk of developing it. For example:

• (Hashimoto's thyroiditis): This causes the thyroid gland to function less (hypothyroidism).
• (Inflammatory bowel disease - IBD): Especially conditions like `(ulcerative colitis)`.
• (Primary biliary cholangitis)
• Retroperitoneal fibrosis: The formation of scar-like tissue in the lining of the back of the abdomen.
• Rheumatoid arthritis: Inflammation of the joints.
• (Sarcoidosis)
• (Sjögren's syndrome)

If you have other autoimmune conditions like this, it's a good idea to be a little concerned about Autoimmune Pancreatitis as well.

What are the symptoms of `(Autoimmune Pancreatitis)`?

In the early stages of this disease , there may be no symptoms . However, as the disease progresses, the pancreatic ducts begin to narrow, preventing the enzymes secreted by the pancreas from being able to pass through properly.

A blockage in the pancreatic duct may cause symptoms such as:

• Upper abdominal pain
• Middle back pain
• Diarrhea
• Nausea/vomiting
• Weight loss

Important: Some of these symptoms can also be seen in pancreatic cancer. Therefore, if you have these symptoms, it is wise not to panic and see a doctor immediately to find out exactly what the problem is . Having `(Autoimmune Pancreatitis)` does not mean that you have cancer.

In addition, autoimmune pancreatitis can cause swelling, non-cancerous growths, and fluid-filled cysts in the pancreas. If these swellings, lumps, or cysts occur in the head of your pancreas, they can block the bile duct, which can prevent bile from flowing properly into the small intestine. Bile contains a pigment called bilirubin. When this bilirubin accumulates in the blood, it can cause jaundice.The skin and whites of the eyes become yellow (jaundice), and you may feel tired. When bilirubin increases in the urine , the urine becomes dark . When bilirubin is excreted in the intestines , the stools may become pale-colored .

What are the possible complications of `(Autoimmune Pancreatitis)`?

Chronic inflammation of the pancreas can cause nausea, weight loss, and persistent pain in the upper abdomen and back. Also, if the insulin-producing cells in the pancreas are damaged , diabetes can develop.

IgG4 antibodies can attack not only the pancreas, but also other organs, especially in Type 1. Such organs include:

• Bile ducts
• Salivary glands
• Lacrimal glands
• Thyroid gland (`Thyroid`)
• Kidneys
• Heart
• Lungs and pleura (lining of the lungs)

How is Autoimmune Pancreatitis diagnosed?

To accurately diagnose this disease and make sure it is not pancreatic cancer, several tests will be needed. You will need to have tests like these:

• Blood tests: These check for abnormally high levels of IgG4, as well as liver function and levels of certain blood cell types.
• Imaging tests: These check the size of the pancreas, whether there are any scars, or whether the ducts are narrowed. Examples of these tests are `(CT scan)` and `(MRI scan)`.
• Biopsy: This involves taking a small piece of tissue from your pancreas and examining it under a microscope. This is usually done through a minimally invasive endoscopic procedure called Endoscopic Ultrasound (EUS). In this procedure, your doctor inserts a long, flexible tube (with a light and ultrasound device on one end) into your stomach and intestines to look at your pancreas. A biopsy sample is then taken through your stomach or intestines. Sometimes, a surgeon may need to make a small incision in your skin (laparoscopy) to take a biopsy sample.
• Corticosteroid trial: This also helps confirm the diagnosis. You are given steroids for a short period of time to see if your IgG4 levels decrease and your imaging tests improve.

How is `(Autoimmune Pancreatitis)` treated?

Surprisingly, for a very small number of people, this disease resolves on its own without any treatment . But for many, treatment is required .

Autoimmune Pancreatitis is mainly treated with corticosteroids.A type of medication called a steroid. For example, a medication like `(prednisone)` or `(prednisolone)`. These medications work by reducing swelling and calming down an overactive immune system. Treatment usually starts with a high dose of steroids. Then the dose is gradually reduced (`tapered`).

If you do not have complications, you usually do not need any additional treatment. The treatment needed depends on the type of complication. If there is a narrowing of the pancreatic duct (`duct narrowing`), a procedure may be performed to open the duct and strengthen it with a hollow mesh device (`stent`).

Can I prevent getting `(Autoimmune Pancreatitis)`?

Actually, there is nothing you can do to prevent this disease from developing because it is a problem with our own immune system.

What is the outlook for people with `(Autoimmune Pancreatitis)`?

Most people recover well after corticosteroid treatment , and there are no complications. Having autoimmune pancreatitis does not affect your life expectancy .

However, `(Autoimmune Pancreatitis)` can recur (relapse) . This is especially common in people with the first type (`Type 1`). The disease is most likely to recur within the first three years after diagnosis. A person who has the disease recurs is also more likely to develop complications.

What happens if the disease recurs?

If managed successfully, even those with recurrent disease can lead active, healthy lives .

You may need to start using corticosteroids again. Some people continue steroid treatment for several years to prevent symptoms from coming back. Doctors may also try other drugs that treat an overactive immune system (immunomodulating and immunosuppressive drugs).

How will I feel during treatment?

Some side effects may occur when using steroids. For example, stomach upset, increased appetite, restlessness, and difficulty sleeping. These side effects can be a little disruptive to daily life, but they are temporary . To get the most out of your Autoimmune Pancreatitis treatment, it is important to continue taking the steroids as prescribed by your doctor .

If the side effects are too bothersome to bear, be sure to inform your doctor before stopping treatment. He or she may prescribe additional treatments to help you get relief, or change your treatment plan.

When can I return to normal activities after treatment for `(Autoimmune Pancreatitis)`?

Steroid treatment usually provides relief from symptoms of `(Autoimmune Pancreatitis)` within a few weeks.Many people return to their normal activities after their symptoms resolve.

Autoimmune Pancreatitis is a rare inflammatory condition that can affect the function of the pancreas. Seeing a doctor who is familiar with pancreatic diseases can help you get the best care you need. Most people make a full recovery after taking steroids . Some people may need additional Autoimmune Pancreatitis treatments to achieve long-term relief.

Finally, remember this (Take-Home Message)

• Autoimmune Pancreatitis is a rare condition in which your own immune system attacks your pancreas.
• If you have symptoms such as abdominal pain, weight loss, or jaundice , be sure to seek medical advice .
• This is not pancreatic cancer, but the symptoms are similar, so a correct diagnosis is essential .
• The main treatment is corticosteroids.
• Many people recover well with treatment, but the disease can recur.
• It is very important to follow the doctor's instructions exactly for a speedy recovery .

Remember, you are not alone. It is normal to have a lot of thoughts running through your mind in a situation like this. So, be open with your doctor and ask your questions. They are here to help you.

` Autoimmune Pancreatitis, Pancreatitis, Autoimmunity, IgG4, Pancreas health, Pancreatitis Sinhala, Digestive health