title: Smoking as a risk factor for complications in chronic pancreatitis.
abstract: OBJECTIVE
  Several recent studies have demonstrated the association between smoking and chronic pancreatitis (CP). However, less is known about the role of smoking in the development of CP-related complications. Our aim was to investigate the impact of smoking and alcohol consumption on age of onset and complications at CP diagnosis.
  
  
  METHODS
  A cross-sectional case-case study was performed within a prospectively collected cohort of patients with CP. Alcohol consumption and smoking habits were assessed using a standardized questionnaire. Morphologic severity was defined based on endoscopic ultrasound criteria for CP and classified as mild (3-4 criteria), moderate (5-6 criteria), and severe (≥7 criteria or calcifications). Pancreatic exocrine insufficiency (PEI) was diagnosed using the C-mixed triglyceride breath test. Odds ratios (OR) with 95% confidence intervals (CI) for CP-related complications were calculated using a case-case design.
  
  
  RESULTS
  A total of 241 patients were included. Smoking was associated with PEI (OR [95% CI], 2.4 [1.17-5.16]), calcifications (OR [95% CI], 2.33 [1.10-4.95]), and severe morphologic changes (OR [95% CI], 3.41 [1.31-8.85]) but not with pseudocysts or diabetes. Neither smoking nor alcohol consumption was associated with age of onset.
  
  
  CONCLUSIONS
  Tobacco, but not alcohol, is associated with PEI, calcifications, and severe morphologic (≥7 criteria or calcifications) CP at diagnosis. Smoking cessation should be encouraged in patients with CP.
authors: From the *Foundation for Research in Digestive Diseases, †Department of Gastroenterology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain; and ‡Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors: María
authors: M
authors: Luaces-Regueira
authors: Julio
authors: J
authors: Iglesias-García
authors: Björn
authors: B
authors: Lindkvist
authors: Margarita
authors: M
authors: Castiñeira-Alvariño
authors: Laura
authors: L
authors: Nieto-García
authors: José
authors: J
authors: Lariño-Noia
authors: J Enrique
authors: JE
authors: Domínguez-Muñoz
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects; D002114:Calcinosis / Q000175:diagnosis* / Q000209:etiology; D003430:Cross-Sectional Studies; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010179:Pancreas / Q000473:pathology; D050500:Pancreatitis, Chronic / Q000175:diagnosis* / Q000209:etiology; D011446:Prospective Studies; D018570:Risk Assessment / Q000706:statistics & numerical data; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D011795:Surveys and Questionnaires