Pancreatite autoimune
Palavras-chave:
Pancreatite autoimune, doença relacionada à IgG4, pancreatite crônica, diagnóstico, tratamentoResumo
Pancreatite autoimune (PAI) é uma doença fibroinflamatória crônica do pâncreas que pertence ao espectro das doenças relacionadas à IgG4. As primeiras descrições da PAI datam da década de 1990. Sua etiologia ainda é idiopática, porém acredita-se tratar de condição multifatorial, envolvendo gatilhos ambientais e resposta imunológica aberrante em indivíduos geneticamente predispostos. Sua forma clínica mais comum é a icterícia indolor, podendo se apresentar com dor abdominal persistente ou, mais raramente, como um quadro exuberante de pancreatite aguda. O diagnóstico se baseia em alterações morfológicas detectadas pelos métodos de imagem, sorologia, características histológicas, e uma resposta significativa à corticoterapia. Seu principal diagnóstico diferencial, especialmente em relação à forma focal da PAI, é o adenocarcinoma ductal, o que, por vezes, pode ser um desafio, tendo o ultrassom endoscópico desempenhado avanços inequívocos nesta importante diferenciação, ao fornecer maior riqueza de detalhes do tecido pancreático e permitir a realização de biópsias. Em relação à terapêutica, o corticoide sistêmico representa o fármaco protagonista, responsável por marcante melhora clínica, além de prevenir o surgimento de complicações tardias, como a insuficiência exócrina e o diabetes. Lamentavelmente, a despeito da rápida e plena recuperação, a PAI se caracteriza por altas taxas de recidiva a longo prazo. O objetivo desta revisão é fornecer uma visão abrangente da pancreatite autoimune e traduzir os conhecimentos científicos mais recentes para a prática clínica.
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