Pancreatic Insufficiency Secondary to Tobacco Exposure A Controlled Cross-Sectional Evaluation

• Authors: Kara L. Raphael, Emory University; Saurabh Chawla, Emory University; Sungjin Kim, Cedars Sinai Medical Center; Christopher G. Keith, Emory University; David Propp, Emory University; Zhengjia Chen, Emory University; Kevin E. Woods, Cancer Treatment Centers of America; Steven Keilin, Emory University; Qiang Cai, Emory University; Field Willingham, Emory University
• Journal Title: Pancreas
• Volume: Volume 46, Number 2
• Publisher: Lippincott, Williams & Wilkins | 2017-02-01, Pages 237-243
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/MPA.0000000000000721
• Subjects: Biology, Biostatistics; Health Sciences, Oncology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Gastroenterology & Hepatology; pancreatic insufficiency; tobacco; smoking; fecal elastase-1; CIGARETTE-SMOKING; RECURRENT ACUTE; ALCOHOL-CONSUMPTION; FECAL ELASTASE-1; UNITED-STATES; RISK; METAANALYSIS; HISTORY; DISEASE; HABITS

Abstract

Objectives: Tobacco exposure is an established risk factor for pancreatic cancer and chronic pancreatitis; however, its role in pancreatic insufficiency is not clear. Methods: This controlled, cross-sectional study examined smokers and nonsmokers with no history of pancreatic disease. Histories and validated inventories of alcohol and tobacco use were obtained, and pancreatic insufficiency was assessed using the fecal elastase-1 assay. Results: Of 7854 patients approached, 226 were interviewed and 200 enrolled. The rates of pancreatic insufficiency [18% (18/100)] and severe pancreatic insufficiency [10% (10/100)] were significantly higher in smokers than in controls [6% (6/100), P = 0.009 and 1% (1/100), P = 0.010, respectively]. On multivariate logistic regression, the risk of pancreatic insufficiency in smokers was significantly increased [odds ratio, 4.34 (1.37-13.75); P = 0.012], controlling for alcohol use and relevant covariates. Tobacco exposure was associated with the highest odds ratio for pancreatic insufficiency. Alcohol consumption was strongly associated with tobacco exposure (P < 0.001), but not with pancreatic insufficiency by multivariate analysis (P = 0.792). Conclusions: This study suggests that tobacco exposure is independently associated with pancreatic exocrine insufficiency in patients without a prior diagnosis of pancreatic disease. Tobacco exposure seems to have greater detrimental effects on pancreatic function than alcohol in this population.