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Dhiraj Yadav, MD, MPH; Robert H. Hawes, MD; Randall E. Brand, MD; Michelle A. Anderson, MD; Mary E. Money, MD; Peter A. Banks, MD; Michele D. Bishop, MD; John Baillie, MB, ChB; Stuart Sherman, MD; James DiSario, MD; Frank R. Burton, MD; Timothy B. Gardner, MD; Stephen T. Amann, MD; Andres Gelrud, MD; Christopher Lawrence, MD; Beth Elinoff, RN, MPH; Julia B. Greer, MD, MPH; Michael O’Connell, PhD; M. Michael Barmada, PhD; Adam Slivka, MD, PhD; David C. Whitcomb, MD, PhD; for the North American Pancreatic Study Group

Arch Intern Med. 2009;169(11):1035-1045.

Background  Recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) are associated with alcohol consumption and cigarette smoking. The etiology of RAP and CP is complex, and effects of alcohol and smoking may be limited to specific patient subsets. We examined the current prevalence of alcohol use and smoking and their association with RAP and CP in patients evaluated at US referral centers.

Methods  The North American Pancreatitis Study 2, a multicenter consortium of 20 US centers, prospectively enrolled 540 patients with CP, 460 patients with RAP, and 695 controls from 2000 to 2006. Using self-reported monthly alcohol consumption during the maximum lifetime drinking period, we classified subjects by drinking status: abstainer, light drinker (0.5 drink per day), moderate drinker (women, >0.5 to 1 drink per day; men, >0.5 to 2 drinks per day), heavy drinker (women, >1 to <5 drinks per day; men, >2 to <5 drinks per day), or very heavy drinker (5 drinks per day for both sexes). Smoking was classified as never, past, or current and was quantified (packs per day and pack-years).

Results  Overall, participants' mean (SD) age was 49.7 (15.4) years; 87.5% were white, and 56.5% were women. Approximately one-fourth of both controls and patients were lifetime abstainers. The prevalence of very heavy drinking among men and women was 38.4% and 11.0% for CP, 16.9% and 5.5% for RAP, and 10.0% and 3.6% for controls. Compared with abstaining and light drinking, very heavy drinking was significantly associated with CP (odds ratio, 3.10; 95% confidence interval, 1.87-5.14) after controlling for age, sex, smoking status, and body mass index. Cigarette smoking was an independent, dose-dependent risk factor for CP and RAP.

Conclusions  Very heavy alcohol consumption and smoking are independent risks for CP. A minority of patients with pancreatitis currently seen at US referral centers report very heavy drinking.

Author Affiliations: Departments of Medicine (Drs Yadav, Greer, O’Connell, Slivka, and Whitcomb and Ms Elinoff) and Human Genetics (Drs Barmada and Whitcomb), University of Pittsburgh, Pittsburgh, Pennsylvania; Digestive Disease Center, Medical University of South Carolina, Charleston (Drs Hawes and Lawrence); Department of Medicine, Evanston Northwestern Healthcare, Chicago, Illinois (Dr Brand); University of Michigan, Ann Arbor (Dr Anderson); Washington County Hospital, Hagerstown, Maryland (Dr Money); Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts (Dr Banks); Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida (Dr Bishop); Department of Medicine, Duke University Medical Center, Durham, North Carolina (Dr Baillie); Department of Medicine, Indiana University Medical Center, Indianapolis (Dr Sherman); Department of Medicine, University of Utah Health Science Center, Salt Lake City (Dr DiSario); Department of Internal Medicine, St Louis University School of Medicine, St Louis, Missouri (Dr Burton); Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire (Dr Gardner); North Mississippi Medical Center, Tupelo (Dr Amann); and Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio (Dr Gelrud).
Group Information: A list of the North American Pancreatic Study Group investigators was published in Pancreatology (2008;8[4-5]:520-531).

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