title: The association of smoking and acute pancreatitis: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Cigarette smoking is an independent risk factor for chronic pancreatitis. We conducted a systematic review of the literature assessing whether cigarette smoking is a risk factor for acute pancreatitis (AP) and recurrent AP (RAP).
  
  
  METHODS
  MEDLINE, PubMed, Embase, and Cochrane Database of Systematic Reviews were searched for studies published from database inception through March 2013. Two investigators independently reviewed articles for eligibility; discordant decisions were resolved by a third investigator's review and consensus. When there were sufficient studies, random-effects meta-analyses were performed by estimating pooled hazards ratios (HRs) with 95% confidence intervals (CIs).
  
  
  RESULTS
  Twelve studies met the eligibility criteria: 7 for AP, 5 for RAP. Compared with never smokers, the risk for AP was significantly increased in current smokers (6 studies; HR, 1.75; 95% CI, 1.26-2.44) and former smokers (5 studies; HR, 1.63; 95% CI, 1.18-2.27). Compared with never smokers, ever smokers were at higher risk for developing RAP (5 studies; HR, 1.59; 95% CI, 1.19-2.12).
  
  
  CONCLUSIONS
  This meta-analysis provides supportive evidence for the association of smoking status and AP. This effect is most pronounced for current smokers, but the risk exists among the former smokers compared with never smokers. There was an increased risk for RAP among ever smokers compared with that among never smokers.
authors: From the *Department of Internal Medicine, University Connecticut Health Center, Farmington, CT; †Center for Health Services Research in Primary Care, Durham VA Medical Center; ‡Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC; and §VA Connecticut Healthcare System, Newington, CT.
authors: Shounak
authors: S
authors: Majumder
authors: Jennifer M
authors: JM
authors: Gierisch
authors: Lori A
authors: LA
authors: Bastian
mesh_terms: D000208:Acute Disease; D006801:Humans; D015233:Models, Statistical; D010195:Pancreatitis / Q000209:etiology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*