Alcohol and Smoking as Risk Factors in an Epidemiology Study of Patients With Chronic Pancreatitis

Abstract

Background & Aims Alcohol has been implicated in the development of chronic pancreatitis (CP) in 60%–90% patients, although percentages in the United States are not known. We investigated the frequency of alcohol-related CP at tertiary U.S. referral centers. Methods We studied data from patients with CP (n=539) and controls (n=695) enrolled in the North American Pancreatitis Study-2 from 2000 to 2006 at 20 U.S. referral centers. CP was defined by definitive evidence in imaging or histologic analyses. Subjects and physicians each completed a detailed study questionnaire. Using physician-assigned diagnoses, patients were assigned to the following etiology groups: alcohol (with/without other diagnoses), non-alcohol (any etiology of CP from other than alcohol), or idiopathic (no etiology identified). Results The distribution of patients among etiology groups were: alcohol (44.5%), non-alcohol (26.9%), and idiopathic (28.6%). Physicians identified alcohol as the etiology more frequently in men (59.4% in men vs 28.1% in women), but non-alcohol (18% in men vs 36.7% in women) and idiopathic etiologies (22.6% in men vs 35.2% in women) more often in women (P<0.01 for all comparisons). Non-alcohol etiologies were equally divided among obstructive, genetic, and other causes. Compared with controls, patients with idiopathic CP were more likely to have ever smoked (58.6% vs 49.7%, P<0.05) or have a history of chronic renal disease or failure (5.2% vs 1.2%, P<0.01). In multivariate analyses, smoking (ever, current, and amount) was independently associated with idiopathic CP. Conclusions The frequency of alcohol-related CP at tertiary U.S. referral centers is lower than expected. Idiopathic CP and non-alcohol etiologies represent a large subgroup, particularly among women. Smoking is an independent risk factor for idiopathic CP.

Should we Investigate Gastroenterology Patients for Pancreatic Exocrine Insufficiency? A Dual Centre UK Study

“…A study of 540 patients with CP reported "cigarette smoking was an independent, dose-dependent risk factor for CP" [4]. Dose dependent relationships have also been demonstrated between smoking and risk of CP (OR 1.65 >100 cigarettes per lifetime, OR 1.8 current smokers, OR 1.87 >1 pack per day) [27]. The benefits of identifying smokers would mean that smoking cessation interventions could be made to reduce the chance of patients without CP developing it in the future.…”

Risk factors for diabetes mellitus in chronic pancreatitis: A cohort of 2,011 patients

“…We also observed a positive correlation between alcohol abuse and DM occurrence in CP patients (HR, 2.00; 95% CI, 1.43-2.79). Alcoholic cause is the most common etiology of CP in western countries, 28 whereas it constitutes 19% in our singlecenter cohort. As suggested by many previous studies, preexisting asymptomatic pancreatic damage might be amplified and accelerated by alcohol intake, therefore increasing the risk of developing DM in CP.…”

Estudo clínico-epidemiológico das pancreatites em um hospital de referência terciária entre 2013 e 2014

“…7,8 Dos oito pacientes com pancreatite alcoólica neste estudo, apenas dois foram classificadas como crônica. Sabe-se que aproximadamente 10% das pessoas com pancreatite crônica desenvolvem ataques de pancreatite clinicamente aguda indistinguíveis de outras formas de pancreatite aguda.…”