Published online Aug 6, 2024. doi: 10.12998/wjcc.v12.i22.5184
Revised: May 14, 2024
Accepted: June 11, 2024
Published online: August 6, 2024
Processing time: 99 Days and 23.7 Hours
Autoimmune pancreatitis (AIP) is a chronic form of pancreatitis characterized by diffused enlargement of the pancreas and irregular stenosis of the main pancreatic duct. Some studies have reported that AIP can cause hemorrhage of gastric varices (GV) related to portal hypertension (PH). However, such cases are rare. In addition, the association of PH with AIP is unclear. At the same time, the efficacy and duration of glucocorticoid therapy is also controversial.
In this case, we reported a case of GV in pancreatic PH associated with AIP. Enhanced abdominal computed tomography (CT) suggested splenic vein (SV) and superior mesenteric vein (SMV) thromboses. The patient received a long-term glucocorticoid therapy, that the initial dose of 40 mg is reduced weekly by 5 mg, and then reduced to 5 mg for long-term maintenance. CT and gastroscopic examination after 8 mo of treatment indicated that SV and SMV were recanalized, pancreatic stiffness and swelling were ameliorated, and the GV almost completely disappeared.
Long-term glucocorticoid therapy can alleviate the development of GV in patients with AIP and has potential reversibility.
Core Tip: Few studies have reported pancreatic portal hypertension (PPH) related to autoimmune pancreatitis (AIP). In our case, the complications of superior mesenteric vein and splenic vein thromboses, splenomegaly, and gastric varicose veins were observed with AIP. After 4 mo and 8 mo of glucocorticoid therapy, thrombus recanalization, disappearance of gastric varices (GV), and spleen shrinkage were observed. Glucocorticoid therapy may reduce the development and potential reversibility of GV in patients with AIP, and patients with PPH associated with AIP will benefit more from active steroid therapy. There remains controversy about the duration of hormone therapy, and long-term follow-up is required.