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Myths and realities about alcohol and smoking in chronic pancreatitis

Singhvi, Ajay; Yadav, Dhiraj

Current Opinion in Gastroenterology: September 2018 - Volume 34 - Issue 5 - p 355–361
doi: 10.1097/MOG.0000000000000466
PANCREAS: Edited by Timothy B. Gardner

Purpose of review Alcohol and smoking play an important role in pancreatitis. The present review will address the myths and evidences about alcohol and smoking with pancreatitis to help improve the approach of healthcare professionals when managing of these patients.

Recent findings There is a growing recognition that chronic pancreatitis is a multifactorial disease. Eliciting an accurate history of alcohol consumption and smoking from patients, and if necessary, family members, can help determine their contribution to the patient's disease. In the absence of a convincing history, physicians should be open to consideration of other etiologies. The amount and duration of alcohol consumption is the most important determinant in increasing pancreatitis risk. Alcohol sensitizes the pancreas to other insults or injury and promotes disease progression. Smoking is an independent risk factor or chronic pancreatitis and has synergistic pathogenic effects with alcohol. The natural history of chronic pancreatitis is highly variable. A patient with alcoholic pancreatitis can have symptoms, recurrences or exacerbations from disease-related complications or nonpancreatic causes. Novel strategies are needed to enable patients quit smoking.

Summary Obtaining accurate history, appropriate evaluation and management can help to achieve meaningful improvement in symptoms in patients with chronic pancreatitis. Abstinence from alcohol and smoking cessation, when applicable, should be recommended in all patients to prevent disease recurrences and progression.

Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

Correspondence to Dhiraj Yadav, MD, MPH, Professor of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, 200 Lothrop St, M2, C-wing, Pittsburgh, PA 15213, USA. Tel: +1 412 864 7078; fax: +1 412 648 9378; e-mail: yadavd@upmc.edu

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