Examining the Causes of Chronic Pancreatitis in Women

Analysis of a multicenter cohort indicates that the causes of chronic pancreatitis vary significantly in men and women and that the phenotype of the disease is independent of patient sex.

Chronic pancreatitis, which is the most common cause of exocrine pancreatic insufficiency, was long considered a disease of alcoholic men, but women accounted for 45% of the 521 cases that were documented in the cohort.

Those women were significantly less likely than their male counterparts to have alcohol-related disease (30% vs 58.5%) and significantly more likely than the men to have disease that stemmed from idiopathic, (32% vs 18%), obstructive (12% vs 2.4%) or genetic (12.8% vs 7.3%) causes.

Male and female patients were demographically similar and experienced comparable levels of pain, exocrine insufficiency, endocrine insufficiency and pancreatitis-related disability. Morphologic findings were similar for members of both groups, as was their use of medications.

Surgical treatments did vary significantly between the 2 groups. Sphincterotomy (biliary, 33% vs 24%; pancreatic, 38% vs 28%; P < 0.05) was performed more frequently in women, whereas cyst/pseudocyst operations were more common in men (6.6% vs 2.6%, P = 0.02).

“Most chronic pancreatitis cases in women are from nonalcoholic etiologies,” the study authors concluded in Pancreas. “In contrast to many other chronic diseases, clinical phenotype of chronic pancreatitis is determined by the disease and is independent of sex.”

The new study bolsters earlier research concluding that alcohol was significantly more likely to be the cause of chronic pancreatitis in men than in women, a fact the seems to stem more from differences in how much men and women drink than in how their bodies process alcohol. A 2002 study that also appeared in Pancreas found that similar amounts of alcohol produce similar instances of chronic pancreatitis in men and women.

Alcohol is the single biggest cause of chronic pancreatitis overall, and its effects escalate in a dose-dependent fashion, according to a 2008 study that appeared in the American Journal of Epidemiology. The authors of that analysis used data from 17,905 patients who participated in the Copenhagen City Heart Study and found that, compared to drinking nothing, hazard ratios associated with drinking 1-6, 7-13, 14-20, 21-34, 35-48, and >48 drinks/week were 1.1, 1.2, 1.3, 1.3, 2.6 and 3.0, respectively (P(trend) < 0.001).

Smoking is also another significant and dose-dependent risk factor for chronic pancreatitis in both sexes, according to a 2007 study of 360 chronic pancreatitis patients.

“Considering never-smokers as the reference class,” the study authors wrote, “ex-smokers had an odds ratio (OR) of 0.56 (95.0% confidence interval [CI], 0.2-1.4; P = not significant), patients smoking 1 to 10 cigarettes per day had an OR of 1.95 (95.0% CI, 1.1-3.4; P < 0.019), patients smoking 11 to 20 cigarettes per day had an OR of 1.76 (95.0% CI, 1.1-2.8; P < 0.0018), and those smoking more than 20 cigarettes per day had an OR of 1.79 (95.0% CI, 1.1-2.9; P < 0.019).”

Other factors known to increase the risk of chronic pancreatitis include celiac disease, inflammatory bowel disease and other autoimmune conditions.