Autoimmune Pancreatitis

What is Autoimmune Pancreatitis?

Autoimmune pancreatitis (AIP) is a rare form of chronic pancreatitis caused by an abnormal immune response against the pancreas, leading to inflammation and scarring.^{[1, 2]} It needs medical diagnosis and treatment, because it can look like pancreatic cancer and is treated with prescription immune-suppressing medicines.

Two main types are recognized. Type 1 is the most common manifestation of IgG4-related disease, a condition with high IgG4 antibody levels that can involve several organs. Type 2 is limited to the pancreas and often occurs with inflammatory bowel disease.^{[2, 3]} A third type, caused by cancer immunotherapy drugs, is also described.^[2]

Common symptoms

The most common sign of type 1 AIP is painless jaundice, a yellowing of the skin and eyes caused by a blocked bile duct.^{[1, 2]}

• Upper abdominal pain, which is more typical of type 2^[2]
• Weight loss^[1]
• High blood sugar, and trouble digesting food when the pancreas loses function^[2]
• In type 1, signs in other organs such as the bile ducts, kidneys, lungs and salivary glands^[2]

Some people have no symptoms and the condition is found on imaging.^[2]

Causes and risk factors

The cause is unknown. The immune system is thought to attack the pancreas, and in type 1 the process is part of a body-wide inflammatory and scarring condition.^{[1, 3]} Type 2 often occurs alongside ulcerative colitis or Crohn disease.^[2]

How it is diagnosed and treated conventionally

Diagnosis combines symptoms, blood tests including IgG4, imaging, and sometimes tissue samples, because AIP must be told apart from pancreatic cancer.^{[1, 3]} Recurrent acute pancreatitis or painless jaundice should prompt an evaluation.^[2]

Glucocorticoids are the cornerstone of treatment, often with other immune-suppressing drugs when steroids are not tolerated or the disease is aggressive.^[3] Type 1 relapses more often than type 2, so maintenance treatment is common.^[3] A report of four patients describes AIP improving without steroids, including two people with no symptoms, but treatment decisions belong with your physician.^[4]

Why Autoimmune Pancreatitis calls for a whole-person approach

Autoimmune pancreatitis can involve other organs and needs long-term follow-up. Treatment also brings its own demands, which is where supportive care may be relevant.

Our role is limited to supportive care after the diagnosis is made and treatment is under way with your physicians.

Other organs and the wider disease

Type 1 AIP is the pancreatic form of a systemic disease and can involve the bile ducts, kidneys, lungs and glands.^{[2, 3]} This is why your gastroenterologist, and sometimes a rheumatologist or kidney specialist, should be monitoring you.

Digestion and blood sugar

When pancreatic tissue is damaged, the body can have trouble digesting food and controlling blood sugar.^[2] Diet and any enzyme or diabetes treatment should be directed by your physician or a dietitian. Supportive herbal or dietary advice must never conflict with that plan.

Long-term treatment and relapse

Because relapses are common in type 1, many people need months to years of treatment and monitoring.^[3] Living with a long-term illness and ongoing medicines can affect sleep, stress and energy.

Stress, sleep and fatigue

Studies of acupuncture in people with cancer suggest possible benefit for fatigue, insomnia and quality of life, though most of the reviews were of low quality.^{[5, 6]} No such studies exist for autoimmune pancreatitis, so this is a reasonable but unproven area for supportive care.

Acupuncture as supportive care in Autoimmune Pancreatitis

What the research shows

No clinical trials of acupuncture in autoimmune pancreatitis were found, so there is no evidence that it affects the disease, relapse risk or antibody levels.

Research on other forms of pancreatitis is limited and does not transfer directly. A meta-analysis of 12 trials in acute pancreatitis found that acupuncture added to routine care was associated with better gastrointestinal function and shorter hospital stay, but only three trials reported side effects and the authors called for better-designed studies.^[7] In a randomized trial of 88 patients with acute pancreatitis, electroacupuncture did not reduce abdominal pain more than standard care alone over four days, although people in the electroacupuncture groups started eating sooner.^[8] A review of non-drug pain treatments in chronic pancreatitis includes acupuncture among the options and stresses personalized, multidisciplinary pain management.^[9] Acute pancreatitis is a different and often serious condition that is treated in hospital.

For symptoms that can accompany a long-term illness, a review of 51 systematic reviews in cancer care found possible benefit for pain, fatigue, insomnia, nausea and quality of life, with most reviews rated as very low quality.^[5] A meta-analysis of acupuncture for insomnia in people with cancer found better sleep than a waiting list in patients with breast cancer on active treatment, but no clear difference from sham acupuncture.^[6]

How acupuncture may work

No mechanism has been shown in autoimmune pancreatitis, and none of the sources above shows how acupuncture might affect immune-mediated pancreatic inflammation. Any benefit for symptoms such as sleep or stress would be an effect on the person, not on the disease.

What treatment involves

Treatment uses fine, sterile, single-use needles, usually left in place for about 20 to 40 minutes. Visits are for general symptoms such as sleep, stress and fatigue, with reassessment after a short course. We do not treat the pancreas with the aim of changing the disease.

Serious problems are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[10] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, have a pacemaker (relevant to electroacupuncture), or take steroids or other immune-suppressing medicines.

Ayurvedic medicine as supportive care in Autoimmune Pancreatitis

The Ayurvedic view

Ayurveda has no classical name for autoimmune pancreatitis. One published case report compared its features with Grahani, a disorder of digestion described as weak digestive fire (Mandagni).^[11] These are traditional categories and not biomedical diagnoses.

Therapies that may be used

Care traditionally emphasizes regular meals suited to your digestion, steady sleep hours and calming routines, with any food changes agreed with your physician or dietitian. Panchakarma procedures such as purgation (Virechana) and medicated enema (Basti) are not appropriate for people with active pancreatitis, jaundice, acute illness, frailty, pregnancy, or those taking steroids or other immune-suppressing drugs. Herbs, if used, are prescribed individually and checked against your medicines (see the herbal section).

What the research shows

The research is very limited. One published case report described a 30-year-old woman with AIP and other conditions who received Virechana and Basti. It reported lower IgG, blood sugar and cholesterol afterward, but it is a single patient who was also on other medicines, so it cannot show that the treatment caused the changes.^[11] No trials of Ayurvedic medicine for AIP were found.

Herbal medicine as supportive care in Autoimmune Pancreatitis

Herbs and formulas that have been studied

No clinical trials of any herb or herbal formula for autoimmune pancreatitis were found.

What the research shows

The evidence for herbal medicine in autoimmune pancreatitis does not exist, and no herb should be used to try to control the disease or lower the need for steroids.

Safety and herb-drug interactions

Safety matters here because treatment often includes steroids, azathioprine, mycophenolate or other immune-suppressing drugs. A scoping review of Chinese herbal medicine and immune-suppressing drugs used in rheumatic disease found 44 interaction pairs, mostly from animal studies, with St John's wort and Schisandra sphenanthera the best documented. It advised that clinicians ask patients about herbal use.^[12] Herbs have also been reported to interact with blood thinners and diabetes medicines.^[13]

Herbal and dietary supplements are a recognized cause of liver injury.^[14] This is a particular concern in people with bile duct or liver involvement. In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[15] Herbs should come from tested sources. Tell us if you are pregnant or breastfeeding, or have liver or kidney disease.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine would describe pancreatic and bile duct symptoms as disharmony of the spleen, liver and gallbladder, with stagnation of qi. Ayurveda would describe weak digestion and a buildup of undigested material (ama). Researchers study digestion, immune activity and inflammation in modern terms, such as the IgG4-associated immune response in type 1 AIP.^[3]

No study has shown that these traditional patterns correspond to the immune process in AIP.

How this care fits with your medical care

Complementary care is an addition to your medical care, not a replacement. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. Do not stop, reduce or change steroids or other prescribed medicines without your prescriber, and keep your scheduled imaging and blood tests.

We do not diagnose or manage autoimmune pancreatitis. Please bring your diagnosis, imaging and IgG4 results, a full medication and supplement list, and the names of your treating doctors. Herbs should not be started until your prescriber has seen that list.

When to seek urgent medical care

New or worsening symptoms may mean a relapse, a complication, or another serious condition, and need prompt medical assessment.^[2]

• Yellow skin or eyes, dark urine or pale stools
• Severe or worsening abdominal pain, especially with vomiting
• Fever or chills, particularly while taking immune-suppressing medicine
• Extreme thirst, frequent urination or confusion, which can signal very high blood sugar
• Unexplained weight loss or inability to keep food down

Call 911 or go to the nearest emergency department for severe abdominal pain, vomiting that will not stop, or any other emergency.