DOI: 10.1097/MPA.0000000000000208
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PMID: 25207661
Issn Print: 0885-3177
Publication Date: 2014/10/01
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Excerpt
We appreciate Hirano et al for their interest in our article1 and for their remarks, showing that lower bile duct stricture found in autoimmune pancreatitis (AIP) is secondary to pancreatic head swelling and should not be included in the classification system of IgG4-related sclerosing cholangitis (IgG4-SC) as type 1 IgG4-SC.
In our study,1 we attempted to clarify the mechanism underlying lower bile duct stricture in autoimmune pancreatitis and concluded the following: (1) both pancreatic head swelling and IgG4-related biliary inflammation affect lower bile duct stricture and (2) an IgG4-related inflammation seemed to exert a dominant effect under limited conditions, including concomitant middle bile duct stricture and neither pancreatic swelling nor pancreatic duct stricture in the head region.
We found that both pancreatic head swelling and IgG4-related biliary inflammation affect lower bile duct stricture of most AIP patients with lower bile duct stricture. In this respect, we consider that lower bile duct stricture found in AIP is included in IgG4-SC irrespective of the dominant factor for lower bile duct stricture. In addition, we had no sufficient evidence to determine which is the dominant factor for lower bile duct stricture when both factors seem to be affecting.
Controversy exists whether lower bile duct stricture found in AIP is secondary to pancreatic head swelling2 or wall thickening due to bile duct inflammation3 or which is the dominant factor. Accordingly, further studies are needed, and classification system for IgG4-SC may be reevaluated in the future.
