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The role of smoking and the development of acute pancreatitis : a systematic review

Majumder S, Bastian L, Gierisch JM. The role of smoking and the development of acute pancreatitis : a systematic review. Paper presented at: American College of Gastroenterology Annual Meeting; 2013 Oct 13; San Diego, CA.




Abstract:

Purpose: Cigarette smoking is a well-known independent risk factor for pancreatic cancer and chronic pancreatitis. Some recent studies have suggested a causative link with acute pancreatitis, as well. We conducted a systematic review of the literature assessing whether (1) cigarette smoking is a risk factor for acute pancreatitis and (2) cigarette smoking is a risk factor for recurrent acute pancreatitis. Methods: We searched MEDLINE(r), PubMed(r), Embase(r), and Cochrane Database of Systematic Reviews for studies published from database inception through March 2013. To be eligible for this review, studies had to meet all the following criteria: English-language, peer-reviewed studies with 20 or more human participants; report quantitative association between exposure to cigarette smoking and acute pancreatitis or recurrent acute pancreatitis; includes comparison group with no tobacco use; and is a pooled patient-level meta-analysis or is a controlled study (e.g. case control ). Two investigators independently reviewed articles for eligibility; discordant decisions were resolved by a third investigator's review and consensus. When possible, random-effects meta-analyses were performed by estimating pooled odds ratios with 95% confidence intervals. We synthesized other studies qualitatively. Results: A total of 1,314 citations were reviewed of which 10 studies were eligible for data abstraction; 7 relevant for acute pancreatitis and 3 for recurrent acute pancreatitis. A meta-analysis of case-control and cohort studies showed acute pancreatitis incidence was slightly but significantly increased in 'current smokers' compared with 'never smokers' (5 studies; OR = 1.95; 95% CI = 1.37-2.78) and 'former smokers' compared to 'never smokers' (5 studies; OR = 1.54; 95% CI = 1.07-2.21). The comparison of 'ever smokers' compared to 'never smokers' demonstrated a similar association but did not reach significance (5 studies; OR = 1.36; 95% CI = 0.92-2.00). Of the studies that examined the development of recurrent acute pancreatitis, there was a range of effects of smoking (3 studies, range OR = 1.24-6.80) for 'ever smokers' compared to 'never smokers'. Conclusion: This systematic review provides supportive evidence for the association of smoking status and acute pancreatitis. This effect is most pronounced for 'current smokers' but it the risk exists even among the 'former smokers' compared to 'never smokers'. There was a trend noted for 'ever smokers' to have an increased risk of recurrent acute pancreatitis. Future studies should examine the impact of smoking cessation and the risk of acute pancreatitis.





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