From the Guidelines
Autoimmune cholecystitis can be identified by a combination of clinical presentation, laboratory findings, and imaging studies, with elevated IgG4 levels, inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and histopathological examination revealing lymphoplasmacytic infiltration and fibrosis being useful markers. The diagnosis of autoimmune cholecystitis, also known as IgG4-related cholecystitis, typically requires a combination of clinical presentation, laboratory findings, imaging studies showing gallbladder wall thickening without stones, and histopathological examination. According to the study by 1, a liver biopsy should be performed in adults suspected of having PSC whose high-quality MRCP is normal, to confirm or exclude small duct PSC.
Some key markers for autoimmune cholecystitis include:
- Elevated IgG4 levels, which can be elevated in IgG4-related cholecystitis
- Inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)
- Histopathological examination revealing lymphoplasmacytic infiltration and fibrosis
- Imaging studies showing gallbladder wall thickening without stones
It is essential to note that the diagnosis of autoimmune cholecystitis can be challenging, and a combination of these markers and clinical presentation is necessary for an accurate diagnosis. As stated in the study by 1, the diagnosis of IAC is proposed to be made in patients with cholangiographic findings typical of sclerosing cholangitis on the basis of histological features of autoimmune pancreatitis (AIP)/IAC or classical imaging findings of AIP and elevated IgG4.
In terms of treatment, immunosuppressive therapy is generally recommended, with corticosteroids like prednisone being first-line, often followed by steroid-sparing agents such as azathioprine or mycophenolate mofetil, as mentioned in the study by 1. Regular monitoring of liver function tests and inflammatory markers is essential to assess treatment response and disease progression.
From the Research
Markers for Autoimmune Cholecystitis
The provided studies do not directly address the markers for autoimmune cholecystitis. However, some studies discuss the markers for autoimmune liver diseases, which may be related to autoimmune cholecystitis.
- The study 2 mentions that autoimmune cholangitis (AIC) is characterized by the presence of high antinuclear antibodies (ANA) or smooth muscle antibodies (SMA) but antimitochondrial antibodies (AMA) seronegativity.
- The study 3 notes that patients with autoimmune cholangitis have lower serum levels of aspartate transaminase (AST), gamma-globulin, and immunoglobulin G, and higher serum levels of alkaline phosphatase compared to patients with type 1 autoimmune hepatitis (AIH).
- The study 4 discusses the importance of liver-related autoantibodies in the diagnosis and classification of autoimmune liver diseases, including AIH, primary biliary cirrhosis (PBC), and sclerosing cholangitis.
- The study 5 highlights the role of autoantibodies in the diagnosis of autoimmune liver diseases, including PBC and AIH, and discusses the different ways in which autoantibodies can be tested.
- The study 6 proposes diagnostic criteria and severity assessment for acute cholecystitis, but does not specifically address autoimmune cholecystitis.
Autoantibodies in Autoimmune Liver Diseases
Some of the autoantibodies mentioned in the studies include:
- Antinuclear antibodies (ANA) 2, 4, 5
- Smooth muscle antibodies (SMA) 2, 4
- Antimitochondrial antibodies (AMA) 2, 4, 5
- Antibody to liver kidney microsomal antigen type-1 (anti-LKM1) 4
- Anti-liver cytosol type 1 (anti-LC1) 4
- Atypical perinuclear antineutrophil cytoplasmic antibody (p-ANCA) 4
Note that these autoantibodies are not specific to autoimmune cholecystitis, but rather to autoimmune liver diseases in general.