Otoimmün Pankreatit
Özet
Otoimmün pankreatit (OİP), kendine has klinik, serolojik ve radyolojik özellikleri olan, kronik pankreatitin nadir ve otoimmün aracılı bir formudur. Literatürde ilk kez 1961'de tanımlanan bu hastalık, 2011 yılındaki uluslararası konsensüs ile Tip 1 ve Tip 2 olmak üzere iki alt gruba ayrılmıştır. Tip 1 OİP, genellikle 60 yaş üstü erkeklerde görülen, yüksek serum IgG4 düzeyleri ve çoklu organ tutulumu ile seyreden sistemik bir hastalıktır. Tip 2 OİP ise daha genç popülasyonda, cinsiyet farkı gözetmeksizin ortaya çıkan, normal IgG4 düzeyleri ile karakterize ve genellikle pankreasa özgü bir durumdur. Hastalar sıklıkla ağrısız obstrüktif sarılık veya karın ağrısı şikayetleriyle başvururlar. Tanıda bilgisayarlı tomografide görülen "sosis benzeri" pankreas görünümü ve histopatolojik incelemeler kritiktir. Tedavinin temelini kortikosteroidler oluşturur; hastaların çoğunda steroid tedavisiyle remisyon sağlanırken, nüks durumlarında immünomodülatörler veya rituksimab gibi ajanlar kullanılabilmektedir. Erken teşhis, gereksiz cerrahi müdahalelerin önlenmesi ve tedavi başarısı açısından hayati önem taşımaktadır.
Autoimmune pancreatitis (AIP) is a rare, autoimmune-mediated form of chronic pancreatitis with distinct clinical, serological, and radiological features. First described in 1961, the disease was classified into two subtypes, Type 1 and Type 2, by the 2011 international consensus. Type 1 AIP is a systemic condition typically seen in men over 60, characterized by elevated serum IgG4 levels and multi-organ involvement. In contrast, Type 2 AIP affects a younger population regardless of gender, features normal IgG4 levels, and is generally limited to the pancreas. Patients commonly present with painless obstructive jaundice or abdominal pain. Diagnosis relies on histopathological examination and the characteristic "sausage-shaped" pancreas appearance on CT scans. Corticosteroids are the primary treatment, inducing remission in most cases, though immunomodulators or agents like rituximab may be used for relapses. Early diagnosis is vital to avoid unnecessary surgery and ensure treatment success.
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