P1057 - Smokers With Chronic Pancreatitis Have Worse Outcomes Than Non-Smokers

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Rachel L. Bocchino, MD

Beth Israel Deaconess Medical Center, Harvard Medical School
Boston, MA, United States

Rachel Bocchino, MD¹, Ishani Shah, MD¹, William Yakah, BS¹, Awais Ahmed, MD¹, Steven D. Freedman, MD, PhD¹, Darshan J. Kothari, MD², Sunil G. Sheth, MD¹
¹Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; ²Duke University Medical Center, Durham, NC

Introduction: Patients with chronic pancreatitis (CP) often have debilitating disease and poor quality of life. Tobacco smoking is an established risk factor for the development and progression of chronic pancreatitis. In this study we aim to compare the clinical characteristics, outcomes, and resource utilization in CP patients with present or former tobacco smoking (SCP) with those who have never smoked (NSCP).

Methods: We retrospectively reviewed all patients with an established diagnosis of CP who were followed in the Pancreas Center at our institution between 2018 and 2020. Patients were considered to be smokers if they reported current or former tobacco smoking. We then compared the demographics, clinical features, comorbidities, outcomes and resource utilization between SCP and NSCP.

Results: We identified 439 patients with CP of which 283 (64%) had a lifetime history of smoking tobacco. A higher proportion of SCP were men (58.3% vs 41.7%; p< 0.001) and had significantly more alcohol dependence (46.9% vs 10.8%;p< 0.001), cardiac disease (35.9% vs 25.6%; p=0.036), pulmonary disease (33.5% vs 23.1%; p=0.030) and psychiatry illness (61.4% vs 37.1%; p< 0.001). A significantly higher proportion of smokers were disabled and/or unemployed, had recurrent acute pancreatitis, chronic abdominal pain, abnormal bowel movements, nausea, local pancreatic complications and exocrine pancreatic insufficiency (Table 1). Opioid and neuromodulator use was higher in smokers (59.2% vs 30.3% and 58.4% vs 31.2%, respectively) and a greater number of SCP patients underwent a celiac plexus block (17.8% vs 7.79%; p=0.007).They also had higher rates of hospitalization for CP flares (2.59 vs 1.75 visits, p=0.014) and more emergency room visits for opioid prescriptions (8.96% vs 3.25%; p=0.041).

Discussion: Our study demonstrates that smokers with CP have greater morbidity than non-smokers reinforcing the importance of smoking cessation. Further studies are needed to understand the impact of smoking cessation on outcomes.

	Never smoker (N=156)	Smoker (N=283)	p-value
Demographics
Age	56.5 (17.0)	59.4 (13.8)	0.061
BMI	25.9 (5.40)	25.7 (5.34)	0.833
Gender			< 0.001
Female	93 (59.6%)	118 (41.7%)
Male	63 (40.4%)	165 (58.3%)
Race			0.009
White	109 (70.8%)	215 (76.0%)
Black	13 (8.44%)	34 (12.0%)
Hispanic	7 (4.55%)	16 (5.65%)
Other	25 (16.2%)	18 (6.36%)
Etiology of CP			0.003
Alcohol	19	129
Biliary	9	23
Idiopathic	95	98
Other	32	33

Comorbidities
Alcohol dependence	17 (10.8%)	133 (46.9%)	< 0.001
Chronic Pain from other diagnosis	21 (14.1%)	44 (15.8%)	0.750
Cardiac disease	40 (25.6%)	101 (35.9%)	0.036
Dementia	3 (1.92%)	8 (2.84%)	0.753
Pulmonary disease	36 (23.1%)	94 (33.5%)	0.030
Liver disease	12 (7.69%)	38 (13.5%)	0.096
CKD	14 (8.97%)	43 (15.2%)	0.085
Malignancy	18 (11.5%)	42 (14.9%)	0.405
Psychiatric illness	58 (37.1%)	174 (61.4%)	< 0.001

Associated Complications
Disabled/Unemployed	16 (11.3%)	57 (21.8%)	0.013
Recurrent acute pancreatitis	85 (54.5%)	197 (69.9%)	0.002
Chronic abdominal pain	102 (65.4%)	219 (77.7%)	0.008
Abnormal bowel movements			0.036
Diarrhea	28 (18.1%)	57 (20.2%)
Steatorrhea	28 (18.1%)	56 (19.9%)
Constipation	13 (8.39%)	47 (16.7%)
Nausea	49 (31.6%)	115 (40.6%)	0.047
Splanchnic vein thrombosis	8 (5.13%)	44 (15.7%)	0.002
Pseudocyst	37 (23.7%)	120 (42.7%)	< 0.001
Biliary obstruction	9 (5.88%)	57 (20.5%)	< 0.001
Exocrine pancreatic insufficiency	72 (46.2%)	185 (65.8%)	< 0.001

Medication & Resource Utilization
Non-opioid controlled medications	28 (18.2%)	93 (33.1%)	0.001
Medical THC	9 (6.29%)	30 (11.2%)	0.154
Opioids	47 (30.3%)	167 (59.2%)	< 0.001
Neuromodulators	48 (31.2%)	164 (58.4%)	< 0.001
Celiac blocks	12 (7.79%)	50 (17.8%)	0.007
Surgery for CP	22 (14.3%)	37 (13.2%)	0.869
Number of flares requiring hospitalization in the last two years	1.75 (3.24)	2.59 (3.42)	0.014
Pain physician	41 (26.5%)	125 (44.5%)	< 0.001
Recurrent ED visits for opioid prescriptions	5 (3.25%)	25 (8.96%)	0.041

Table: Comparison of Patients with Chronic Pancreatitis Who Have Never Smoked and Patients with Any Lifetime History of Smoking

Disclosures:

Rachel Bocchino indicated no relevant financial relationships.

Ishani Shah indicated no relevant financial relationships.

William Yakah indicated no relevant financial relationships.

Awais Ahmed indicated no relevant financial relationships.

Steven Freedman indicated no relevant financial relationships.

Darshan Kothari indicated no relevant financial relationships.

Sunil Sheth indicated no relevant financial relationships.

Rachel Bocchino, MD¹, Ishani Shah, MD¹, William Yakah, BS¹, Awais Ahmed, MD¹, Steven D. Freedman, MD, PhD¹, Darshan J. Kothari, MD², Sunil G. Sheth, MD¹. P1057 - Smokers With Chronic Pancreatitis Have Worse Outcomes Than Non-Smokers, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.