Smoking is underrecognized as a risk factor for chronic pancreatitis.
OBJECTIVE
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, 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. and IAP.
Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA. yadavd@upmc.edu
Dhiraj
D
Yadav
Adam
A
Slivka
Stuart
S
Sherman
Robert H
RH
Hawes
Michelle A
MA
Anderson
Frank R
FR
Burton
Randall E
RE
Brand
Michele D
MD
Lewis
Timothy B
TB
Gardner
Andres
A
Gelrud
James
J
Disario
Stephen T
ST
Amann
John
J
Baillie
Christopher
C
Lawrence
Michael
M
O'Connell
Albert B
AB
Lowenfels
Peter A
PA
Banks
David C
DC
Whitcomb
D005260:Female; D006801:Humans; D008297:Male; D050500:Pancreatitis, Chronic / Q000209:etiology*; D010819:Physician's Role; D012307:Risk Factors; D057566:Self Report; D012907:Smoking / Q000009:adverse effects*
Cochrane Database Syst Rev. 2008 Apr 16;(2):CD000165
18425860
Gastroenterology. 2001 Feb;120(3):682-707
11179244
Am J Gastroenterol. 2004 Apr;99(4):731-8
15089909
Am J Gastroenterol. 2009 Nov;104(11):2797-805; quiz 2806
19603011
Digestion. 1978;18(5-6):337-50
750261
Eur J Gastroenterol Hepatol. 2001 Jun;13(6):749-50
11434607
Digestion. 1973;9(5):416-28
4784703
Gastroenterology. 1984 May;86(5 Pt 1):820-8
6706066
Am J Gastroenterol. 1994 Sep;89(9):1467-71
8079921
Dig Dis Sci. 1999 Jul;44(7):1303-11
10489910
Pancreas. 2000 Aug;21(2):109-14
10975702
Gut. 2005 Apr;54(4):510-4
15753536
Arch Intern Med. 2009 Mar 23;169(6):603-9
19307524
Pancreatology. 2002;2(5):469-77
12378115
Am J Epidemiol. 1982 Sep;116(3):407-14
7124709
Pancreas. 1987;2(6):694-7
3438307
Pancreas. 1990 Jul;5(4):479-83
2381902
Pancreas. 2007 Nov;35(4):320-6
18090237
Arch Intern Med. 2009 Jun 8;169(11):1035-45
19506173
Pancreas. 2006 Aug;33(2):163-8
16868482
Pancreatology. 2008;8(4-5):520-31
18765957
J Gastroenterol. 2007 Feb;42(2):101-19
17351799
Scand J Gastroenterol. 1982 Mar;17(2):247-52
7134849
Pancreas. 2000 Aug;21(2):115-9
10975703
Gastroenterology. 1994 Nov;107(5):1481-7
7926511
Gut. 1991 Nov;32(11):1392-5
1752475
Alcohol Res Health. 2006;29(3):162-71
17373404
Pancreatology. 2008;8(1):63-70
18235217