Increased awareness enhances physician recognition of the role of smoking in chronic pancreatitis
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Keywords

pancreatitis, etiology, risk factors, smoking, doctors’ awareness

How to Cite

Muniraj, T., Yadav, D., Abberbock, J. N., Alkaade, S., Amann, S. T., Anderson, M. A., Banks, P. A., Brand, R. E., Conwell, D., Cote, G. A., Forsmark, C. E., Gardner, T. B., Gelrud, A., Guda, N., Lewis, M. D., Romagnuolo, J., Sandhu, B. S., Sherman, S., Singh, V. K., Slivka, A., Tang, G., Whitcomb, D. C., & Wilcox, C. M. (2020). Increased awareness enhances physician recognition of the role of smoking in chronic pancreatitis. Herald of Pancreatic Club, 48(3), 23-31. https://doi.org/10.33149/vkp.2020.03.04

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Abstract

Background: We have previously reported that physicians under-recognize smoking as a chronic pancreatitis (CP) risk factor. We hypothesized that availability of empiric data will influence physician recognition of this relationship.

Methods: We analyzed data from 508 CP patients prospectively enrolled in the North American Pancreatitis Study-2 Continuation and Validation (NAPS2-CV) or NAPS2-Ancillary (AS) studies (2008–2014) from 26 US centers who self-reported ever-smoking. Information on smoking status, physician-defined etiology and identification of smoking as a CP risk factor was obtained from structured patient and physician questionnaires. We compared how often physician identified smoking as a CP risk factor in NAPS2-CV/NAPS2-AS studies with NAPS2-original study (2000–2006).

Results: Enrolling physician identified smoking as a risk factor in significantly (all p< 0.001) greater proportion of patients in NAPS2-CV/AS studies when compared with NAPS2-original study among ever (80.7 vs. 45.3%), current (91.3 vs. 53%), past (60.3 vs. 30.2%) smokers, in those who smoked ≤1 pack/day (79.3 vs. 39.5%) or ≥1 packs/day (83 vs. 49.8%). In multivariable analyses, the enrolling physician was 3.32–8.49 times more likely to cite smoking as a CP risk factor in the NAPS2-CV/NAPS2-AS studies based on smoking status and amount after controlling for age, sex, race and alcohol etiology. The effect was independent of enrolling site in a sub-analysis limited to sites participating in both phases of enrollment.

Conclusions: Availability of empiric data likely enhanced physician recognition of the association between smoking and CP. Wide-spread dissemination of this information could potentially curtail smoking rates in subjects with and those at risk of CP.

https://doi.org/10.33149/vkp.2020.03.04
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References

1. A clinical practice guideline for treating tobacco use and dependence: 2008 update. A U.S. Public Health Service report. Am. J. Prev. Med. 2008. Vol. 35, No 2. P. 158–176.
2. David T. P., Venglovecz V., Eleondéra G., Téth K., Schntir A., Maléth J., Csupor D., Rakonczay Jr Z., Hegyi P. Cigarette Smoke Extract Inhibits Fluid and HCO3-secretion and CFTR activity in Guinea pig pancreatic ductal cells. Pancreatol. Off. J. Int. Assoc. Pancreatol. (IAP) [et al]. 2017. Vol. 17, No 3. P. S48.
3. Etemad B., Whitcomb D. C. Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology. 2001. Vol. 120, No 3. P. 682–707.
4. Greer J. B., Thrower E., Yadav D. Epidemiologic and mechanistic associations between smoking and pancreatitis. Curr. Treat Options Gastroenterol. 2015. Vol. 13, No 3. P. 332–346.
5. Han S., Kheder J., Bocelli L., et al. Smoking cessation in a chronic pancreatitis population. Pancreas. 2016. Vol. 45, No 9. P. 1303–1308.
6. Hegyi P., Wilschanski M., Muallem S., et al. CFTR: a new horizon in the path-omechanism and treatment of pancreatitis. Rev. Physiol. Biochem. Pharmacol. 2016. Vol. 170. P. 37–66.
7. Lugea A., Gerloff A., Su H. Y., et al. The combination of alcohol and cigarette smoke induces endoplasmic reticulum stress and cell death in pancreatic acinar cells. Gastroenterology. 2017. Vol. 153, No 6. P. 1674–1686.
8. Sankaran S. J., Xiao A. Y., Wu L. M., Windsor J. A., Forsmark C. E., Petrov M. S. Frequency of progression from acute to chronic pancreatitis and risk factors: a meta-analysis. Gastroenterology. 2015. Vol. 149, No 6. P. 1490-1500.
9. Siu A. L. Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U.S. Preventive Services task Force recommendation statement. Ann. Intern. Med. 2015. Vol. 163, No 8. P. 622–634
10. Sliwinska-Mosson M., Milnerowicz H., Jablonowska M., Milnerowicz S., Nabzdyk S., Rabczynski J. The effect of smoking on expression of IL-6 and antioxidants in pancreatic fluids and tissues in patients with chronic pancreatitis. Pancreatol. Off. J. Int. Assoc. Pancreatol. (IAP) [et al]. 2012. Vol. 12, No 4. P. 295–304.
11. Talamini G., Bassi C., Falconi M., et al. Smoking cessation at the clinical onset of chronic pancreatitis and risk of pancreatic calcifications. Pancreas. 2007. Vol. 35, No 4. P. 320–326.
12. Whitcomb D. C., Frulloni L., Garg P., et al. Chronic pancreatitis: an international draft consensus proposal for a new mechanistic definition. Pancreatol. Off. J. Int. Assoc. Pancreatol. (IAP) [et al]. 2016. Vol. 16, No 2. P. 218–224.
13. Whitcomb D. C., Yadav D., Adam S., et al. Multicenter approach to recurrent acute and chronic pancreatitis in the United States: the North American Pancreatitis Study 2 (NAPS2). Pancreatol. Off. J. Int. Assoc. Pancreatol. (IAP) [et al]. 2008. Vol. 8, No 4–5. P. 520–531.
14. Wilcox C. M., Sandhu B. S., Singh V., et al. Racial differences in the clinical profile, causes, and outcome of chronic pancreatitis. Am. J. Gastroenterol. 2016. Vol. 111, No 10. P. 1488–1496.
15. Wilcox C. M., Yadav D., Ye T., et al. Chronic pancreatitis pain pattern and severity are independent of abdominal imaging findings. Clin. Gastroenterol. Hepatol. Off. Clinic Pract. J. Am. Gastroenterol. Assoc. 2015. Vol. 13, No 3. P. 552–560. Quiz e528–559.
16. Xue J., Zhao Q., Sharma V., et al. Aryl hydrocarbon receptor ligands in cigarette smoke induce production of interleukin-22 to promote pancreatic fibrosis in models of chronic pancreatitis. Gastroenterology. 2016. Vol. 151, No 6. P. 1206–1217.
17. Yadav D., Hawes R. H., Brand R. E., et al. Alcohol consumption, cigarette smoking, and the risk of recurrent acute and chronic pancreatitis. Arch. Intern. Med. 2009. Vol. 169, No 11. P. 1035–1045.
18. Yadav D., Lowenfels A. B. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 2013. Vol. 144, No 6. P. 1252–1261.
19. Yadav D., Slivka A., Sherman S., et al. Smoking is underrecognized as a risk factor for chronic pancreatitis. Pancreatol. Off. J. Int. Assoc. Pancreatol. (IAP) [et al]. 2010. Vol. 10, No 6. P. 713–719.
20. Ye X., Lu G., Huai J., Ding J. Impact of smoking on the risk of pancreatitis: a systematic review and meta-analysis. PLoS One. 2015. Vol. 10, No 4. P. e0124075.
21. Yen S., Hsieh C. C., MacMahon B. Consumption of alcohol and tobacco and other risk factors for pancreatitis. Am. J. Epidemiol. 1982. Vol. 116, No 3. P. 407–414.