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The role of alcohol and smoking in pancreatitis

Abstract

Chronic alcohol use has been linked to chronic pancreatitis for over a century, but it has not been until the last decade that the role of alcohol in chronic pancreatitis has been elucidated in animals and, only in recent years, in human populations. Although a dose-dependent association between alcohol consumption and chronic pancreatitis may exist, a staistical association has been shown only with the consumption of ≥5 alcoholic drinks per day. Smoking also confers a strong, independent and dose-dependent risk of pancreatitis that may be additive or multiplicative when combined with alcohol. Alcohol increases the risk of acute pancreatitis in several ways and, most importantly, changes the immune response to injury. Genetic factors are also important and further studies are needed to clarify the role of gene–environment interactions in pancreatitis. In humans, aggressive interventional counseling against alcohol use may reduce the frequency of recurrent attacks of disease and smoking cessation may help to slow the progression of acute to chronic pancreatitis.

Key Points

  • Studies suggest that a threshold of approximately 5 alcoholic drinks per day must be exceeded before the risk of chronic pancreatitis in individuals who drink alcohol exceeds that of the nondrinking population

  • Only a minority of patients with pancreatitis have a significant history of alcohol consumption, suggesting that most patients have a complex genetic disorder that is similar to other chronic inflammatory diseases

  • Smoking is a dose-dependent risk factor for pancreatitis, and its effects are additive or multiplicative when combined with alcohol

  • Chronic alcohol use at high daily doses (that is, ≥5 drinks daily) increases susceptibility to, and severity of, acute pancreatitis and accelerates the progression of chronic pancreatitis

  • Aggressive counseling leading to reduced alcohol consumption may reduce the likelihood of recurrent acute pancreatitis

  • Smoking cessation may slow the progression of chronic pancreatitis

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Figure 1: Progression from pre-acute pancreatitis to chronic pancreatitis.
Figure 2: Distribution of self-reported alcohol consumption and smoking among patients with chronic pancreatitis in the North American Pancreatitis Study 2 (NAPS2).
Figure 3: Alcohol consumption and risk of pancreatitis in participants of the Copenhagen City Heart Study.60
Figure 4: Absolute risk of pancreatitis, and hazard ratios, according to smoking status in participants of a Danish study.128
Figure 5: Working model of the sites and systems in which alcohol and smoking modify pancreatitis risk and progression.

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Yadav, D., Whitcomb, D. The role of alcohol and smoking in pancreatitis. Nat Rev Gastroenterol Hepatol 7, 131–145 (2010). https://doi.org/10.1038/nrgastro.2010.6

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