title: Smoking and the course of recurrent acute and chronic alcoholic pancreatitis: a dose-dependent relationship.
abstract: OBJECTIVE
  Smoking has been shown to affect the course of alcoholic chronic pancreatitis (ACP). However, a dose-dependent relationship between ACP course and the amount of tobacco consumption has not been studied.
  
  
  METHODS
  All consecutive smokers with ACP were included prospectively. Thresholds were defined at 10, 15, 20, and 30 pack-years (p.y.) to assess the relationship between tobacco intake and ACP complications. Statistical adjustment on alcohol intake was performed.
  
  
  RESULTS
  One hundred eight patients (male, 86%) were included. The median tobacco intake was 30 p.y. (range, 3-90 p.y.) Pancreatic calcifications and duct abnormalities were observed in 70% and 73%, respectively. Pancreatic exocrine insufficiency and diabetes mellitus were observed in 36% and 30%, respectively. No differences in ACP outcome were seen at 10-p.y. threshold. At a 15-p.y. threshold, ACP diagnosis was made earlier (36 versus 46 years; P = 0.0036). At a 20-p.y. threshold, ACP occurred earlier (P = 0.0002), and the patients had more often calcifications (P = 0.05). Similar results were observed at the 30-p.y. threshold, but additionally pancreatic exocrine insufficiency occurred earlier (P = 0.04).
  
  
  CONCLUSIONS
  Tobacco intake accelerates the course of ACP in a dose-dependent fashion, apart from the amount of alcohol intake. A major threshold effect is seen in 20 p.y.
authors.affiliation: Pôle des Maladies de l'Appareil Digestif, Service de Gastroentérologie-Pancréatologie, Hôpital Beaujon, AP-HP, Clichy, France. vinciane.rebours@bjn.aphp.fr
authors.forename: Vinciane
authors.initials: V
authors.lastname: Rebours
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Vullierme
authors.forename: Olivia
authors.initials: O
authors.lastname: Hentic
authors.forename: Frédérique
authors.initials: F
authors.lastname: Maire
authors.forename: Pascal
authors.initials: P
authors.lastname: Hammel
authors.forename: Philippe
authors.initials: P
authors.lastname: Ruszniewski
authors.forename: Philippe
authors.initials: P
authors.lastname: Lévy
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D003920:Diabetes Mellitus / Q000209:etiology; D004305:Dose-Response Relationship, Drug; D010188:Exocrine Pancreatic Insufficiency / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000002:abnormalities / Q000187:drug effects; D019512:Pancreatitis, Alcoholic / Q000150:complications / Q000503:physiopathology*; D011446:Prospective Studies; D012008:Recurrence; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects*