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P100. Characteristics of ulcerative colitis associated with autoimmune pancreatitis

B. Ye1, D. Kim1, S. Yang1, D. Yang1, K. Jung1, K. Kim1, J. Byeon1, S. Myung1, J. Kim2, J. Kim1

1Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea; 2Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea

Aim: Various systemic extra-pancreatic lesions of autoimmune pancreatitis (AIP), such as sialadenitis, sclerosing cholangitis, and retroperitoneal fibrosis etc., show abundant IgG4-positive cell infiltration on the involved organs. Recently, some cases of ulcerative colitis (UC) were also suggested to be associated with AIP. However, the prevalence of UC in AIP patients together with the clinical characteristics and outcomes of UC associated with AIP (AIP-UC) are not clear yet.

Materials and Method: We retrospectively reviewed the medical records of AIP patients who were diagnosed at the Asan Medical Center. The prevalence of UC in AIP patients and the clinical features and prognosis of AIP-UC compared with matched UC patients without AIP (UC alone group), by a ratio of 1:4, were investigated.

Results: A total of 104 patients diagnosed with AIP between October 2000 and September 2010 were reviewed. Among these, 6 AIP-UC patients (5.8%) were identified. In the AIP-UC group, 4 patients (66.7%) were male and the median age at diagnosis of UC was 23 years. Serum IgG and IgG4 were elevated in 1 patient (16.7%), respectively, and the pathologic findings of AIP showed idiopathic duct-centric chronic pancreatitis in 4 patients (66.7%). When we compared AIP-UC group and UC alone group, AIP-UC group showed lower body mass index (P = 0.003) and higher CRP level (P = 0.048) at diagnosis of UC, compared with the UC alone group. The Mayo score at diagnosis of UC was higher in AIP-UC than UC alone group (P = 0.006). Two patients (33.3%) in AIP-UC group, but no patient in the UC alone group showed increased numbers of IgG4-positive cells (10 per high-power field) on the colonic tissue. During the follow-up period, 2 patients (33.3%) underwent total colectomy and 1 patient (16.7%) died in the AIP-UC group, but none of the UC alone group underwent colectomy or died.

Conclusions: AIP patients appear to have higher risk of UC compared with the general population. The finding of increased IgG4-positive cells on the colonic tissue suggests that UC may be one of extra-pancreatic manifestation of AIP. Patients with both AIP and UC may have a poorer prognosis suggested by increased colectomy rate and mortality compared with patients with UC alone.

Keywords: Ulcerative colitis, Autoimmune pancreatitis, IgG4