title: Cigarette smoking accelerates progression of alcoholic chronic pancreatitis.
abstract: BACKGROUND
  Smoking is a recognised risk factor for pancreatic cancer and has been associated with chronic pancreatitis and also with type II diabetes.
  
  
  OBJECTIVE
  The aim of this study was to investigate the effect of tobacco on the age of diagnosis of pancreatitis and progression of disease, as measured by the appearance of calcification and diabetes.
  
  
  METHODS
  We used data from a retrospective cohort of 934 patients with chronic alcoholic pancreatitis where information on smoking was available, who were diagnosed and followed in clinical centres in five countries.
  
  
  METHODS
  We compared age at diagnosis of pancreatitis in smokers versus non-smokers, and used the Cox proportional hazards model to evaluate the effects of tobacco on the development of calcification and diabetes, after adjustment for age, sex, centre, and alcohol consumption.
  
  
  RESULTS
  The diagnosis of pancreatitis was made, on average, 4.7 years earlier in smokers than in non-smokers (p = 0.001). Tobacco smoking increased significantly the risk of pancreatic calcifications (hazard ratio (HR) 4.9 (95% confidence interval (CI) 2.3-10.5) for smokers v non-smokers) and to a lesser extent the risk of diabetes (HR 2.3 (95% CI 1.2-4.2)) during the course of pancreatitis.
  
  
  CONCLUSIONS
  In this study, tobacco smoking was associated with earlier diagnosis of chronic alcoholic pancreatitis and with the appearance of calcifications and diabetes, independent of alcohol consumption.
authors.affiliation: Epidemiology Unit, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. patrick.maisonneuve@ieo.it
authors.forename: P
authors.initials: P
authors.lastname: Maisonneuve
authors.forename: A B
authors.initials: AB
authors.lastname: Lowenfels
authors.forename: B
authors.initials: B
authors.lastname: Müllhaupt
authors.forename: G
authors.initials: G
authors.lastname: Cavallini
authors.forename: P G
authors.initials: PG
authors.lastname: Lankisch
authors.forename: J R
authors.initials: JR
authors.lastname: Andersen
authors.forename: E P
authors.initials: EP
authors.lastname: Dimagno
authors.forename: A
authors.initials: A
authors.lastname: Andrén-Sandberg
authors.forename: L
authors.initials: L
authors.lastname: Domellöf
authors.forename: L
authors.initials: L
authors.lastname: Frulloni
authors.forename: R W
authors.initials: RW
authors.lastname: Ammann
mesh_terms: D000328:Adult; D017668:Age of Onset; D002114:Calcinosis / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology; D018450:Disease Progression; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000209:etiology; D019512:Pancreatitis, Alcoholic / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D013997:Time Factors
chemical_list: D000431:Ethanol