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The Association of Smoking and Acute Pancreatitis: A Systematic Review and Meta-analysis

Majumder, Shounak MD*; Gierisch, Jennifer M. PhD, MPH†‡; Bastian, Lori A. MD, MPH

doi: 10.1097/MPA.0000000000000301
Original Articles
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Objectives Cigarette smoking is an independent risk factor for chronic pancreatitis. We conducted a systematic review of the literature assessing whether cigarette smoking is a risk factor for acute pancreatitis (AP) and recurrent AP (RAP).

Methods MEDLINE, PubMed, Embase, and Cochrane Database of Systematic Reviews were searched for studies published from database inception through March 2013. Two investigators independently reviewed articles for eligibility; discordant decisions were resolved by a third investigator's review and consensus. When there were sufficient studies, random-effects meta-analyses were performed by estimating pooled hazards ratios (HRs) with 95% confidence intervals (CIs).

Results Twelve studies met the eligibility criteria: 7 for AP, 5 for RAP. Compared with never smokers, the risk for AP was significantly increased in current smokers (6 studies; HR, 1.75; 95% CI, 1.26–2.44) and former smokers (5 studies; HR, 1.63; 95% CI, 1.18–2.27). Compared with never smokers, ever smokers were at higher risk for developing RAP (5 studies; HR, 1.59; 95% CI, 1.19–2.12).

Conclusions This meta-analysis provides supportive evidence for the association of smoking status and AP. This effect is most pronounced for current smokers, but the risk exists among the former smokers compared with never smokers. There was an increased risk for RAP among ever smokers compared with that among never smokers.

From the *Department of Internal Medicine, University Connecticut Health Center, Farmington, CT; †Center for Health Services Research in Primary Care, Durham VA Medical Center; ‡Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC; and §VA Connecticut Healthcare System, Newington, CT.

Received for publication April 23, 2014; accepted September 3, 2014.

Reprints: Shounak Majumder, MD, Mayo Clinic, Division of Gastroenterology and Hepatology, 200 1st Street SW, Rochester, MN 55905 (e-mail: majumder.shounak@mayo.edu).

The authors declare no conflict of interest.

Dr Lori Bastian is the guarantor of the article.

Author contributions: S.M., J.M.G., and L.A.B. conceived and drafted the study, collected the data, and drafted the manuscript. J.M.G., and L.A.B. analyzed and interpreted the data. All coauthors approved the final draft before submission.

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

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