Comparison of the Mannheim Diagnostic Criteria of autoimmune pancreatitis with other diagnosic criteria systems

Introduction: Different diagnostic criteria for autoimmune pancreatitis (AiP) have been developed in various centers from Europe, USA and Asia. We recently developed the Mannheim AiP Diagnostic Criteria. A consensus about the different diagnostic systems has not been reached.

Objectives: To compare the Mannheim AiP Diagnostic Criteria with other diagnostic systems.

Methods: Mannheim AiP Diagnostic Criteria define „definite“, „probable“ and „possible“ AiP. „Mannheim Definite AiP“ is diagnosed in patients fullfilling Mayo HISORt or Asian AiP Criteria; or simultaneously presenting with pancreatic disease, other autoimmune disease and/or elevated autoantibodies, and disease response to steroids. „Mannheim Probable AiP“ is diagnosed with pancreatic disease, elevated IgG4 and/or other autoantibodies, and other autoimmune disease. „Mannheim Possible AiP“ is diagnosed with pancreatic disease and either elevated IgG4 and/or other autoantibodies, or other autoimmune disease. Patients with non-alcoholic pancreatitis from our clinic (1997–2009) were studied. In patients with „Mannheim Definite AiP“, we compared the Mannheim AiP Diagnostic Criteria with Japan-, Korean-, Asian-, Mayo HISORt-, Revised Mayo HISORt- and Italian-Criteria.

Results: We detected „Mannheim Definite AiP“ in n=21 patients. In n=5/21 patients, pancreatic histology was obtained by surgery. In only these patients, diagnosis of AiP could be established by any diagnostic system. In n=8/21 patients, the diagnosis of AiP was only achieved with the Mannheim AiP Diagnostic Criteria. In this cohort of patients, all individuals responded to steroid medication.

Conclusion: The Mannheim AiP Diagnostic Criteria are superior to other criteria systems and allow the diagnosis of AIP in atypical forms of the disease.