Published online Dec 21, 2023. doi: 10.3748/wjg.v29.i47.6161
Peer-review started: September 22, 2023
First decision: November 1, 2023
Revised: November 10, 2023
Accepted: November 21, 2023
Article in press: November 21, 2023
Published online: December 21, 2023
Processing time: 88 Days and 0.1 Hours
Autoimmune pancreatitis (AIP) is a complex, poorly understood disease gaining increasing attention. "Clinical Characteristics and Outcome of AIP Based on Serum IgG4 levels," investigated AIP with a focus on serum immunoglobulin (Ig) G4 levels. The 213 patients with AIP were classified according to serum IgG4 levels: Abnormal (elevated) and normal. Patients with higher IgG4 levels exhibited a more active immune system and increased relapse rates. Beyond IgG4, the IgA levels and age independently contributed to relapse risk, guiding risk assessment and tailored treatments for better outcomes. However, limitations persist, such as no IgA correlation with IgG4 levels, absent data on autoantibody-positive AIP cases critical for Asian diagnostic criteria, and unexplored relapse rates in high serum IgG AIP by subtype. Genetic factors and family histories were not addressed. As the understanding and referral of seronegative AIPs increase, there's a growing need for commercially available, highly sensitive, and specific autoantibodies to aid in diagnosing individuals with low or absent serum IgG4 levels.
Core Tip: The study on autoimmune pancreatitis (AIP) based on serum immunoglobulin (Ig) G4 levels offers valuable insights into this complex condition. Elevated IgG4 and IgA levels in patients with AIP were associated with more active immune system and higher relapse rates, highlighting the potential of IgG4 as a biomarker. However, limitations include the lack of analysis on IgA levels in relation to IgG4 levels, the absence of data on autoantibodies, and the lack of reporting on family history and genetic factors. As awareness of AIP grows, there is a need for highly sensitive and specific autoantibodies to aid in diagnosis, especially for IgG4-negative AIP patients.