ArticleGut2002
Cigarette smoking, appendectomy, and tonsillectomy as risk factors for the development of primary sclerosing cholangitis: a case control study.
Article in Gut, 2002. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
33 citing papers in PubMed, 3 syntheses or guidelines pooled it, 117 citations in OpenAlex.
- The epidemiological trends and projected future of primary sclerosing cholangitis by 2040: An updated meta-analysis and modeling study.PloS one · 2025Pooled it
- Primary sclerosing cholangitis and the risk of cancer, cardiovascular disease, and all-cause mortality: a systematic review and meta-analysis of cohort studies.Scientific reports · 2021Pooled it
- Pooled it
- The Detection of Cholangiocarcinoma in Primary Sclerosing Cholangitis Patients: Single Center Experience.Journal of gastrointestinal cancer · 2016Trial
- Appendectomy, tonsillectomy, and risk of inflammatory bowel disease: a case control study in Iran.International journal of colorectal disease · 2006Trial
- Primary Sclerosing Cholangitis: Diagnosis, Management, and Clinical Challenges.Journal of clinical medicine · 2026Review
- Dietary and Lifestyle Risk Factors in Primary Sclerosing Cholangitis: In Search of Mechanistic Explanations and Health Improvement.The Journal of nutrition · 2025Review
- Missing Causality and Heritability of Autoimmune Hepatitis.Digestive diseases and sciences · 2023Article
- Multitrait genome-wide analyses identify new susceptibility loci and candidate drugs to primary sclerosing cholangitis.Nature communications · 2023Article
- The intestinal and biliary microbiome in autoimmune liver disease-current evidence and concepts.Seminars in immunopathology · 2022Review
- The Epidemiology of UK Autoimmune Liver Disease Varies With Geographic Latitude.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2021Article
- Sex-related factors in autoimmune liver diseases.Seminars in immunopathology · 2019Review
- Review of pharmacotherapeutic treatments for primary sclerosing cholangitis.Canadian liver journal · 2019Review
- Article
- Association between smoking and risk of primary sclerosing cholangitis: A systematic review and meta-analysis.United European gastroenterology journal · 2018Article
- Epigenetics in the Primary Biliary Cholangitis and Primary Sclerosing Cholangitis.Seminars in liver disease · 2017Article
- A comprehensive assessment of environmental exposures among 1000 North American patients with primary sclerosing cholangitis, with and without inflammatory bowel disease.Alimentary pharmacology & therapeutics · 2015Article
- Frequency and risk factors of primary sclerosing cholangitis among patients with inflammatory bowel disease in North-East of Iran.Gastroenterology and hepatology from bed to bench · 2015Article
- Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis: a Review Featuring a Women's Health Perspective.Journal of clinical and translational hepatology · 2014Review
- Mechanisms of tissue injury in autoimmune liver diseases.Seminars in immunopathology · 2014Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
aimsThe strong clinical association between primary sclerosing cholangitis (PSC) and ulcerative colitis (UC) suggests common factors in their pathogenesis. Smoking, previous appendectomy, and tonsillectomy have been associated with a decreased risk of developing UC. In this study, our aim was to examine these risk factors in patients with PSC with and without underlying inflammatory bowel disease (IBD).
methodsThe smoking habits and history of previous appendectomy and/or tonsillectomy of 170 patients with PSC, 41 without underlying IBD, 170 patients with UC but normal liver function tests, and 170 age and sex matched community controls were obtained by questionnaire.
resultsA total of 112 PSC patients (66%) had never smoked compared with 66 controls (39%). Only 12 PSC patients (7%) were current smokers versus 43 controls (25%). The resultant odds ratio of having PSC was 0.17 (95% confidence interval (CI) 0.08-0.35) among current smokers and 0.33 (95% CI 0.21-0.52) among ever (former+current) smokers. Among former smokers, the odds of having PSC were also significantly decreased (odds ratio 0.45, 95% CI 0.26-0.73; p<0.05). In the subgroup of PSC patients without IBD, only 5% were current smokers versus 26% of matched controls, and never smokers were overrepresented (68% v 37%). The rate of previous appendectomy was similar in all three study groups (14%, 12%, and 13%) but the frequency of tonsillectomy was reduced in the PSC group (21% v 31%; p=0.05).
conclusionPSC, like UC, is a disease of non-smokers as the odds of having PSC was significantly decreased among current and former smokers. The association between non-smoking and PSC was independent of whether the PSC patient had underlying IBD. Previous tonsillectomy but not appendectomy may also be associated with a decreased risk of PSC but this warrants further study.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.