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Cigarette smoking accelerates progression of alcoholic chronic pancreatitis
  1. P Maisonneuve1,
  2. A B Lowenfels2,
  3. B Müllhaupt3,
  4. G Cavallini4,
  5. P G Lankisch5,
  6. J R Andersen6,
  7. E P DiMagno7,
  8. Å Andrén-Sandberg8,
  9. L Domellöf9,
  10. L Frulloni4,
  11. R W Ammann3
  1. 1Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
  2. 2Departments of Surgery and Community and Preventive Medicine, New York Medical College, Valhalla NY, USA
  3. 3Gastroenterology Service, Department of Medicine, University Hospital, Zurich, Switzerland
  4. 4Department of Surgical and Gastroenterological Sciences, University of Verona, Italy
  5. 5Department of Internal Medicine, Municipal Clinic, Lüneburg, Germany
  6. 6Department of Gastroenterology, Hvidovre Hospital, University of Copenhagen, Denmark
  7. 7Gastrointestinal Research Unit, Mayo Clinic, Rochester, MN, USA
  8. 8Department of Surgery, Lund University, Sweden
  9. 9Department of Surgery, University Hospital Örebro, Sweden
  1. Correspondence to:
    Dr P Maisonneuve
    Epidemiology Unit, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy;


Background: Smoking is a recognised risk factor for pancreatic cancer and has been associated with chronic pancreatitis and also with type II diabetes.

Aims: The aim of this study was to investigate the effect of tobacco on the age of diagnosis of pancreatitis and progression of disease, as measured by the appearance of calcification and diabetes.

Patients: We used data from a retrospective cohort of 934 patients with chronic alcoholic pancreatitis where information on smoking was available, who were diagnosed and followed in clinical centres in five countries.

Methods: We compared age at diagnosis of pancreatitis in smokers versus non-smokers, and used the Cox proportional hazards model to evaluate the effects of tobacco on the development of calcification and diabetes, after adjustment for age, sex, centre, and alcohol consumption.

Results: The diagnosis of pancreatitis was made, on average, 4.7 years earlier in smokers than in non-smokers (p = 0.001). Tobacco smoking increased significantly the risk of pancreatic calcifications (hazard ratio (HR) 4.9 (95% confidence interval (CI) 2.3–10.5) for smokers v non-smokers) and to a lesser extent the risk of diabetes (HR 2.3 (95% CI 1.2–4.2)) during the course of pancreatitis.

Conclusions: In this study, tobacco smoking was associated with earlier diagnosis of chronic alcoholic pancreatitis and with the appearance of calcifications and diabetes, independent of alcohol consumption.

  • chronic alcoholic pancreatitis
  • diabetes
  • calcification
  • tobacco smoking

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  • Conflict of interest: None declared.

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