title: Heavy Smoking Is Associated With Lower Age at First Episode of Acute Pancreatitis and a Higher Risk of Recurrence.
abstract: OBJECTIVE
  There is limited data on cigarette smoking and the risk of acute pancreatitis (AP). We evaluated the influence of cigarette smoking on AP risk and clinical presentation in a large cohort of Veteran's Administration (VA) patients.
  
  
  METHODS
  Retrospective study of VA patients from 1998 to 2007. Exclusion criteria included (1) history of chronic pancreatitis (n = 3222) or gallstones (n = 14,574) and (2) age younger than 15 years (n = 270). A 2-year washout period was used to exclude patients with pre-existing recurrent AP.
  
  
  RESULTS
  The study included 484,624 patients. From 2001 to 2007, a total of 6799 (1.4%) patients had AP. Alcohol (risk ratio, 4.20) and smoking (risk ratio, 1.78) were independent significant risk factors of AP on multiple regression analysis. Smoking increased the risk of AP in both nonalcoholics (0.57% vs 1.1%) and alcoholics (2.6% vs 4.1%). Smoking was associated with younger mean age at first episode of AP and higher likelihood of recurrent AP (≥4 episodes) in both nonalcoholics and alcoholics. The interval between recurrent episodes was not altered by alcohol or smoking.
  
  
  CONCLUSIONS
  In a large cohort of VA patients, smoking is an independent risk factor for AP and augmented the effect of alcohol on the risk, age of onset, and recurrence of AP.
authors.affiliation: From the *Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saint Louis University, St Louis, MO; †Center for Pancreatic Disease, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and ‡Center for Pancreatic Disorders, Division of Gastroenterology, University of Chicago, Chicago, IL.
authors.forename: Satish
authors.initials: S
authors.lastname: Munigala
authors.forename: Darwin L
authors.initials: DL
authors.lastname: Conwell
authors.forename: Andres
authors.initials: A
authors.lastname: Gelrud
authors.forename: Banke
authors.initials: B
authors.lastname: Agarwal
mesh_terms: D000208:Acute Disease; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010195:Pancreatitis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D019512:Pancreatitis, Alcoholic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D058014:Veterans Health