Smoking Cessation at the Clinical Onset of Chronic Pancreatitis and Risk of Pancreatic Calcifications

Talamini, Giorgio; Bassi, Claudio; Falconi, Massimo; Sartori, Nora; Vaona, B.; Bovo, P.; Benini, Luigi; Cavallini, Giorgio; Pederzoli, Paolo; Vantini, Italo

doi:10.1097/mpa.0b013e31812e965e

Cited by 70 publications

(33 citation statements)

References 26 publications

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“…A recent population-based study identified the attributable risk associated with smoking for pancreatitis to be 46% [18] . Clinical data also support associations between smoking and CP risk and progression [19][20][21][22][23] . Thus, the available evidence points toward a strong role for smoking in the development and progression of CP.…”

Section: Discussionmentioning

confidence: 89%

“…Smoking has been linked to the evolution from acute to CP [19] and progression of CP [20][21][22]. Moreover, smoking cessation after CP diagnosis may slow disease progression [23]. Therefore, recognition of smoking as a risk factor for CP provides an opportunity for counseling and smoking cessation as an intervention for primary and secondary prevention.…”

Section: Introductionmentioning

confidence: 99%

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Smoking Is Underrecognized as a Risk Factor for Chronic Pancreatitis

et al. 2011

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physicians cited smoking as a risk factor in only 173/382 (45.3%). Physicians cited smoking as a risk factor more often among current smokers, when classifying alcohol as CP etiology, and with higher amount and duration of smoking. We observed a wide variability in physician decision to cite smoking as a risk factor. Multivariable regression analysis however confirmed that the association of CP with smoking was independent of physician decision to cite smoking as a risk factor. Conclusions: Physicians often underrecognize smoking as a CP risk factor. Efforts are needed to raise awareness of the association between smoking and CP. Key WordsChronic pancreatitis ؒ Smoking ؒ Alcohol ؒ Risk factor Abstract Background/Aims: Smoking is an established risk factor for chronic pancreatitis (CP). We sought to identify how often and in which CP patients physicians consider smoking to be a risk factor. Methods: We analyzed data on CP patients and controls prospectively enrolled from 19 US centers in the North American Pancreatitis Study-2. We noted each subject's self-reported smoking status and quantified the amount and duration of smoking. We noted whether the enrolling physician (gastroenterologist with specific interest in pancreatology) classified alcohol as the etiology for CP and selected smoking as a risk factor. Results: Among 382/535 (71.4%) CP patients who were self-reported ever smokers,

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Smoking Is Underrecognized as a Risk Factor for Chronic Pancreatitis

et al. 2011

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“…In one study, current smokers were at a 7.8-times greater risk than that of non-smokers (95% CI 2.2, 27.3) for CP; whereas ex-smokers were at decreased risk compared to current smokers (OR 1.7, 95% CI 0.4, 6.3) [5]. In another study, ex-smokers who quit smoking within 5 years of CP diagnosis were at decreased risk for pancreatic calcifications compared with never-smokers [19]. The classification of smoking as current-smoker vs. non-smoker seems more clinically applicable since clinicians do not always probe for remote smoking habits.…”

Section: Discussionmentioning

confidence: 99%

Cigarette Smoking Is Independently Associated with Chronic Pancreatitis

et al. 2010

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“…There is no evidence and hence no recommendation for smoking cessation in CP and PEI despite some reports, 5,15 even in acute pancreatitis. [2][3][4][5] Smoking cessation is recommended (Evidence 3b, recommendation A).…”

Section: General Measurementsmentioning

confidence: 99%

Synopsis of recent guidelines on pancreatic exocrine insufficiency

Löhr

Oliver²,

Frulloni

2013

UEG Journal

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Background: In recent years, three national gastroenterology societies established guidelines for the diagnosis and therapy of pancreatic exocrine insufficiency (PEI). In addition, the Cochrane Collaboration issued a review. Objective: The purpose of this paper is to present an overview of the recommendations and concordance between the four recent published guidelines and stimulate further discussion. Methods: A review of the Australian, German and Italian guidelines and the Cochrane review was conducted, and a synthesis was made of common statements.Results: There is a high degree of agreement on almost all items within these guidelines, both in the diagnosis of PEI and in terms of therapy and approach to management of PEI. In addition, novel emerging developments are highlighted, such as the fecal elastase-1 test, which is widely used but is not suitable for measuring mild-to-moderate PEI despite its ability to positively establish the diagnosis of severe PEI. One of the few novel tests proving to be useful is the 13 C mixed-chain triglycerides (MCT) breath test. This test, albeit an excellent quantitative test, is not widely used and is rarely available. The use of this test is making it apparent that there is a difference between treating the symptoms of PEI and treating malnutrition, the broader underlying defect. This may have direct consequences for the dosing of pancreatic enzymes (pancreatin), in that the consensus starting dose of all guidelines may be too low for some patients. Although chronic pancreatitis in adults and cystic fibrosis in children account for the main evidence base used for PEI, other indications are also discussed. Conclusions: There is good concordance between recommendations provided by international groups. More prospective studies are required in many areas, including the use of pancreatic enzymes in other gastrointestinal disorders, such as celiac disease and irritable bowel syndrome (IBS). We also need to assess the feasibility of the 13 C MCT breath test. At the same time, it needs to be confirmed that higher doses of pancreatic enzymes are really necessary to not only relieve the symptoms of PEI but also treat malnutrition appropriately.

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Smoking Cessation at the Clinical Onset of Chronic Pancreatitis and Risk of Pancreatic Calcifications

Abstract: Smoking cessation in the first years from the clinical onset of CP reduces the risk of developing pancreatic calcifications.

Cited by 70 publications

References 26 publications

Smoking Is Underrecognized as a Risk Factor for Chronic Pancreatitis

Smoking Is Underrecognized as a Risk Factor for Chronic Pancreatitis

Cigarette Smoking Is Independently Associated with Chronic Pancreatitis

Synopsis of recent guidelines on pancreatic exocrine insufficiency

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