Association between smoking and risk of primary sclerosing cholangitis: A systematic review and meta-analysis

Karn Wijarnpreecha, Panadeekarn Panjawatanan, Omar Y. Mousa, Wisit Cheungpasitporn, Surakit Pungpapong, Patompong Ungprasert

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations


Background/Objectives: Studies have suggested that smokers may have a lower risk of primary sclerosing cholangitis (PSC) although the results have been inconsistent. This systematic review and meta-analysis was conducted to summarize all available data to better characterize this association. Methods: A comprehensive literature review was conducted using Medline and Embase databases through January 2018 to identify all studies that compared the risk of PSC among current/former smokers versus nonsmokers. Effect estimates from each study were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird. Results: Seven case-control studies with 2,307,393 participants met the eligibility criteria and were included in the meta-analysis. The risk of PSC among current smokers and former smokers was significantly lower than nonsmokers with the pooled odds ratio of 0.31 (95% CI, 0.18–0.53) and 0.52 (95% CI, 0.44–0.61), respectively. The risk remained significantly lower among current smokers and former smokers compared with nonsmokers even when only patients with PSC without inflammatory bowel disease were included. Conclusions: A significantly decreased risk of PSC among current and former smokers was demonstrated in this study.

Original languageEnglish (US)
Pages (from-to)500-508
Number of pages9
JournalUnited European Gastroenterology Journal
Issue number4
StatePublished - May 1 2018


  • Primary sclerosing cholangitis
  • cholangitis
  • cigarettes
  • meta-analysis
  • smoking

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology


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