Roles of alcohol and smoking as risks for pancreatitis reassessed

Although alcohol consumption is known to be associated with chronic pancreatitis, new evidence indicates that a threshold of five or more drinks per day is required to significantly raise risk; however, most patients with chronic pancreatitis do not drink this amount, according to a new report.
The report followed a study in which doctors examined the current prevalence of alcohol use and smoking and their association with pancreatitis in 1,000 patients enrolled in the North American Pancreatitis Study 2.

About one-fourth of both controls and patients were lifetime abstainers. Among those with chronic pancreatitis, 38.4 per cent of men and 11 per cent of women were very heavy drinkers (five or more drinks per day), compared with 16.9 per cent of men and 5.5 per cent of women with recurrent acute pancreatitis and 10 per cent of men and 3.6 per cent of women in the control group.
“We found the threshold drinking amount for association between alcohol use and chronic pancreatitis to be five or more drinks per day,” the authors reported.
Compared with abstaining and light drinking (half a drink per day or less), very heavy drinking was associated with approximately triple the odds of developing chronic pancreatitis. However, fewer patients with chronic pancreatitis than expected – about one-fourth – drank at this level. Other factors, including genetic mutations, also contribute to pancreatitis risk.
Although many heavy drinkers also smoked, cigarette use was an independent risk factor for both chronic pancreatitis and recurrent acute pancreatitis. Among smokers, those with chronic pancreatitis tended to smoke more and had smoked for a longer period of time, suggesting a dose-dependent effect.
“In conclusion, only very heavy alcohol consumption and cigarette smoking are independent risk factors for chronic pancreatitis,” the authors concluded. “Risk for chronic pancreatitis from alcohol consumption occurs above a threshold level, while risk due to smoking is dose dependent. Drinking levels in subjects with recurrent acute pancreatitis are similar to controls. Only a minority of patients with recurrent acute pancreatitis and chronic pancreatitis currently seen at secondary or tertiary US centres could be categorised as very heavy drinkers.”
Archives of Internal Medicine 2009;169:1035-1045