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. 2022 Jan;57(1):91-98.
doi: 10.1080/00365521.2021.1984573. Epub 2021 Oct 18.

Impact of genetic testing and smoking on the distribution of risk factors in patients with recurrent acute and chronic pancreatitis

Merve Gurakar  1 , Niloofar Y Jalaly  2 , Mahya Faghih  3 , Tina Boortalary  4 , Javad R Azadi  5 , Mouen A Khashab  6 , Christopher Fan  6 , Anthony N Kalloo  3   6 , Atif Zaheer  3   5 , Vikesh K Singh  3   6 , Elham Afghani  3   6
Affiliations

Impact of genetic testing and smoking on the distribution of risk factors in patients with recurrent acute and chronic pancreatitis

Merve Gurakar et al. Scand J Gastroenterol. 2022 Jan.

Abstract

Objective: The aim of the present study is to assess the impact of smoking dose and duration on the distribution of risk factor(s) in patients with RAP and CP, and the impact of genetic testing on the distribution of risk factor(s) in patients with idiopathic RAP and CP.

Methods: All adult patients with RAP and CP referred to a multidisciplinary pancreatitis clinic between 2010 and 2017 were evaluated. Risk factors included alcohol and smoking, hypertriglyceridemia, biliary, and other etiologies. Genetic testing was only pursued in patients with idiopathic RAP or CP.

Results: Among the 1770 patients evaluated, 167 had RAP and 303 had CP. After genetic testing and smoking, the most common risk factors for RAP and CP were pathogenic variant(s) (23%) and the combination of alcohol and smoking (23%), respectively. Genetic testing and smoking assessment decreased the proportion of patients with alcoholic RAP from 17% to 5%, alcoholic CP from 33% to 10%, idiopathic RAP from 49% to 12%, and idiopathic CP from 54% to 14%. Pathogenic CFTR variants were the most common variant in patients with RAP (51%) and CP (43%). Among the 68 patients with pancreas divisum, other risk factor(s) were identified in 72%.

Conclusion: Genetic testing and a detailed assessment of smoking dose and duration reduce the proportion of patients with alcoholic and idiopathic pancreatitis. Other risk factor(s) for pancreatitis are found in the majority of patients with pancreas divisum further questioning its role as an independent risk factor.1. What is the current knowledge?Approximately 30% of patients with pancreatitis have no clear risk factor(s) and are categorized as having an idiopathic etiology.Pathogenic variant(s) as well as smoking dose and duration are well-established risk factors for recurrent acute and chronic pancreatitis but are not widely recognized or incorporated into clinical practice.2. What is new here?Genetic testing and a detailed assessment of smoking dose and duration reduced the proportion of patients with alcoholic and idiopathic acute recurrent and chronic pancreatitis.Approximately three-fourths of patients with pancreas divisum have a risk factor for pancreatitis.

Keywords: Recurrent acute pancreatitis; chronic pancreatitis; genetic testing; risk factors; smoking.

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Conflict of interest statement

Disclosure statement

E. A. is a medical advisory board participant for Nestle Health Science. V. K. S. is a consultant for AbbVie and Nestle Health Science; medical advisory board participant for Cook Medical, and receives grant support from Orgenesis, Theraly, and AbbVie. M. K. is a consultant for BSCI, Medtronic, Olympus, and GI Supply. These financial interests do not pertain directly to this work. For the remaining authors, no conflict of interest was declared.

Figures

Figure 1-
Figure 1-
Study cohort
Figure 2A –
Figure 2A –. Distribution of risk factors in patients with recurrent acute pancreatitis
*Genetic testing was performed only in patients with idiopathic recurrent acute pancreatitis
Figure 2B –
Figure 2B –. Distribution of risk factors in patients with chronic pancreatitis
*Genetic testing was performed only in patients with idiopathic chronic pancreatitis
Figure 3-
Figure 3-
Distribution of pathogenic variant(s) in patients with unexplained pancreatitis
Figure 4-
Figure 4-
Distribution of risk factors in recurrent acute pancreatitis and chronic pancreatitis patients with pancreas divisum after genetic and smoking assessments
See this image and copyright information in PMC

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