title: Does tobacco influence the natural history of autoimmune pancreatitis?
abstract: Tobacco recently appeared as a major independent factor adversely influencing the natural course of alcoholic chronic pancreatitis. However, the role of tobacco in patients with autoimmune pancreatitis (AIP) has never been studied. Type 2 AIP is associated with inflammatory bowel disease, especially ulcerative colitis in which smoking is protective. The aim of our study was to evaluate the influence of smoking on course of AIP.
  
  
  METHODS
  All consecutive patients followed in our centre for AIP according to ICDC were studied. Tobacco consumption was recorded. A relation between smoking and all event related to AIP was searched for.
  
  
  RESULTS
  96 patients with type 1 (73%) or type 2 (27%) AIP were included; 76% of patients were low smokers (never, ex- or smokers <10 p.y.) and 24% were high smokers (≥10 p.y.). The mean follow-up was 60 months [5-188]. AIP relapse was observed in 26% of patients. At the end-point, smokers ≥10 p.y. presented more frequently diabetes (50% vs 27%, p = 0.04) and imaging pancreatic damages (59% vs 34%, p = 0.02) than low smokers. There was also a non significant tendency to observe more frequently exocrine insufficiency and relapse in smokers ≥10 pack-year. No protective effect of smoking was observed in the subgroup of patients with type 2 AIP and ulcerative colitis.
  
  
  CONCLUSIONS
  In patients with AIP, high tobacco intake is associated with the risk of imaging pancreatic damages and with the occurrence of diabetes. Smoking cessation should be recommended.
authors: Department of Gastroenterology and Pancreatology, Beaujon Hospital, AP-HP, Clichy, and Paris-Diderot University, Paris, France. Electronic address: frederique.maire@bjn.aphp.fr.
authors: Frédérique
authors: F
authors: Maire
authors: Department of Gastroenterology and Pancreatology, Beaujon Hospital, AP-HP, Clichy, and Paris-Diderot University, Paris, France.
authors: Vinciane
authors: V
authors: Rebours
authors: Department of Radiology, Beaujon Hospital, AP-HP, Clichy, and Paris-Diderot University, Paris, France.
authors: Marie Pierre
authors: MP
authors: Vullierme
authors: Department of Pathology, Beaujon Hospital, AP-HP, Clichy, and Paris-Diderot University, Paris, France.
authors: Anne
authors: A
authors: Couvelard
authors: Department of Gastroenterology and Pancreatology, Beaujon Hospital, AP-HP, Clichy, and Paris-Diderot University, Paris, France.
authors: Philippe
authors: P
authors: Lévy
authors: Department of Gastroenterology and Pancreatology, Beaujon Hospital, AP-HP, Clichy, and Paris-Diderot University, Paris, France.
authors: Olivia
authors: O
authors: Hentic
authors: Department of Gastroenterology and Pancreatology, Beaujon Hospital, AP-HP, Clichy, and Paris-Diderot University, Paris, France.
authors: Maxime
authors: M
authors: Palazzo
authors: Department of Gastroenterology and Pancreatology, Beaujon Hospital, AP-HP, Clichy, and Paris-Diderot University, Paris, France.
authors: Pascal
authors: P
authors: Hammel
authors: Department of Gastroenterology and Pancreatology, Beaujon Hospital, AP-HP, Clichy, and Paris-Diderot University, Paris, France.
authors: Philippe
authors: P
authors: Ruszniewski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001327:Autoimmune Diseases / Q000139:chemically induced* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology; D010195:Pancreatitis / Q000139:chemically induced* / Q000473:pathology; D012907:Smoking / Q000009:adverse effects*; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult; D014026:Nicotiana
keywords: Autoimmune pancreatitis; Diabetes; Exocrine insufficiency; Relapse; Smoking; Ulcerative colitis