Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Department of Medicine, Georgetown University, Washington, DC, USA.
Scand J Gastroenterol. 2022 Jan;57(1):91-98. doi: 10.1080/00365521.2021.1984573. Epub 2021 Oct 18.
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.
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.
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%.
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.
本研究旨在评估吸烟剂量和持续时间对 RAP 和 CP 患者危险因素分布的影响，以及遗传检测对特发性 RAP 和 CP 患者危险因素分布的影响。
对 2010 年至 2017 年间在多学科胰腺炎诊所就诊的所有成年 RAP 和 CP 患者进行评估。危险因素包括酒精和吸烟、高三酰甘油血症、胆源性和其他病因。仅对特发性 RAP 或 CP 患者进行遗传检测。
在评估的 1770 例患者中，167 例为 RAP，303 例为 CP。在进行遗传检测和吸烟评估后，RAP 和 CP 最常见的危险因素分别是致病性变异（23%）和酒精与吸烟的组合（23%）。遗传检测和吸烟评估将酒精性 RAP 患者的比例从 17%降至 5%，酒精性 CP 患者的比例从 33%降至 10%，特发性 RAP 患者的比例从 49%降至 12%，特发性 CP 患者的比例从 54%降至 14%。在 RAP（51%）和 CP（43%）患者中，最常见的变异是致病性 CFTR 变异。在 68 例胰腺分裂症患者中，72%的患者还发现了其他危险因素。
遗传检测和详细评估吸烟剂量和持续时间可降低酒精性和特发性胰腺炎患者的比例。在大多数胰腺分裂症患者中还发现了其他胰腺炎危险因素，这进一步质疑了其作为独立危险因素的作用。1. 目前的知识水平如何？大约 30%的胰腺炎患者没有明确的危险因素，被归类为特发性病因。致病性变异以及吸烟剂量和持续时间是复发性急性和慢性胰腺炎的已确立危险因素，但尚未得到广泛认可或纳入临床实践。2. 这里的新发现是什么？遗传检测和详细评估吸烟剂量和持续时间降低了酒精性和特发性急性复发性和慢性胰腺炎患者的比例。大约四分之三的胰腺分裂症患者有胰腺炎的危险因素。
