Smoking and hepato-biliary disease

The effect of cigarette smoking has been assessed in several hepato-biliary diseases, although in only a few was smoking the main focus of the study. Other than in primary sclerosing cholangitis, the relationships found are n ot strong and it remains unclear whether any are causal in nature - particu larly in the absence of clearly demonstrated biological mechanisms. Neverth eless, many studies have found a modest but definite association between sm oking and gallstone disease, As smoking is so prevalent in many countries, the public health impact of even a weak causal relationship would be consid erable. (C) 2000 Lippincott Williams & Wilkins.