scholarly journals Pre-Pouch Ileitis is Associated with Development of Crohn’s Disease-Like Complications and Pouch Failure

2020 ◽  
Author(s):  
Gaurav Syal ◽  
Ron Shemtov ◽  
Nirupama Bonthala ◽  
Eric A Vasiliauskas ◽  
Edward J Feldman ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Immunosuppressive Therapy ◽  
Bowel Disease ◽  
Free Survival ◽  
Pouch Failure ◽  
Anastomotic Strictures ◽  
Increased Risk ◽  
Inflammatory Bowel

Abstract Background and Aims It is unclear whether pre-pouch ileitis heralds an aggressive inflammatory pouch disease in patients with ileal-pouch anal anastomosis (IPAA). We compared outcomes of patients with pouchitis and concomitant pre-pouch ileitis to those with pouchitis alone. Methods Patients undergoing IPAA surgery for inflammatory bowel disease who subsequently developed pouchitis with concomitant pre-pouch ileitis (pre-pouch ileitis group) were matched by year of IPAA surgery and pre-operative diagnosis (ulcerative colitis or inflammatory bowel disease-unclassified) with patients who developed pouchitis alone (pouchitis group). Primary outcomes were development of Crohn’s disease (CD)-like complications (non-anastomotic strictures or perianal disease >6 months after ileostomy closure) and pouch failure. Secondary outcomes were need for surgical/endoscopic interventions and immunosuppressive therapy. Log-rank test was used to compare outcome-free survival and Cox regression was performed to identify predictors of outcomes. Results There were 66 patients in each group. CD-like complications and pouch failure developed in 36.4% and 7.6% patients in pre-pouch ileitis group and 10.6% and 1.5% in pouchitis group, respectively. CD-like complications-free survival (log-rank p=0.0002) and pouch failure-free survival (log-rank p=0.046) were significantly lower in the pre-pouch ileitis group. Pre-pouch ileitis group had a higher risk of requiring surgical/endoscopic interventions (log-rank p=0.0005) and immunosuppressive therapy (log-rank p<0.0001). Pre-pouch ileitis was independently associated with an increased risk of CD-like complications (HR 3.8; p=0.0007), need for surgical/endoscopic interventions (HR 4.1; p=0.002) and immunosuppressive therapy (HR 5.0; p=0.0002). Conclusions Pre-pouch ileitis is associated with a higher risk of complicated disease and pouch failure than pouchitis. It should be considered a feature of CD.

scholarly journals Replication and Meta-Analysis of 13,000 Cases Defines the Risk for Interleukin-23 Receptor and Autophagy-Related 16-Like 1 Variants in Crohn’s Disease

2010 ◽  
Vol 24 (5) ◽  
pp. 297-302 ◽  
Author(s):  
Lynn Cotterill ◽  
Debbie Payne ◽  
Scott Levison ◽  
John McLaughlin ◽  
Emma Wesley ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bowel Disease ◽  
Meta Analysis ◽  
European Ancestry ◽  
Published Data ◽  
Increased Risk ◽  
Inflammatory Bowel ◽  
Interleukin 23

BACKGROUND/OBJECTIVE: Variants in the interleukin-23 receptor (IL23R) and the autophagy-related 16-like 1 (ATG16L1) genes have been associated with an increased risk of Crohn’s disease (CD). Both genes were identified through genome-wide association scans and subsequent studies have validated these associations. To assess the effect size of these variants, an independent case-control association study and meta-analysis were performed.METHODS: British Caucasian subjects with inflammatory bowel disease (n=500) and 877 ethnically matched controls were genotyped for the disease-associated variants inIL23RandATG16L1. In addition, meta-analyses of 12,991 patients and 14,598 controls, and 11,909 patients and 15,798 controls, were conducted on independently published data for the associations betweenIL23RandATG16L1variants and CD, respectively.RESULTS: In the present cohort, both susceptibility variants showed highly significant associations, includingIL23R(rs11209026, P=0.0006; OR 0.37; 95% CI 0.21 to 0.67) andATG16L1(rs2241880, P=0.0017; OR 1.36; 95% CI 1.12 to 1.66). The meta-analysis based on the random effects model showed similar combined effects for rs11209026 (n=26, OR 0.41; 95% CI 0.37 to 0.46) and rs2241880 (n=25, OR 1.33; 95% CI 1.28 to 1.39). There was no statistically significant gene-gene interaction between caspase recruitment domain (CARD15) variants and theIL23RorATG16L1polymorphisms (P=0.44 and P=0.24, respectively).CONCLUSION: The present cohort and meta-analysis provides strong evidence that, in addition toCARD15, polymorphisms in bothIL23RandATG16L1alter susceptibility to CD and that these effects are consistent across all populations of European ancestry; however, onlyATG16L1is relevant to inflammatory bowel disease in the Asian population.

scholarly journals Cancer Risk in Inflammatory Bowel Disease

1995 ◽  
Vol 9 (1) ◽  
pp. 23-26 ◽  
Author(s):  
Anders M Ekbom
Keyword(s):  
Colorectal Cancer ◽  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bowel Disease ◽  
Colonic Involvement ◽  
Increased Risk ◽  
Inflammatory Bowel ◽  
Risk Of Cancer

There is an increased risk of cancer in both ulcerative colitis and Crohn's disease. In 3121 patients with ulcerative colitis, 225 cases of cancer were diagnosed compared with 142.1 expected (standardized incidence ratio [SIR] 1.6, 95% CI 1.4 to 1.8), and in 1655 patients with Crohn's disease, 58 cases of cancer were detected compared with 47.1 expected (SIR 1.2, 95% CI 0.9 to 1.6). After excluding colorectal cancer the observed number of malignancies was very close to that expected for ulcerative colitis (SIR 1.0, 95% CI 0.9 to 1.2) and for Crohn's disease (SIR 1.1, 95% CI 0.8 to 1.5). Thus, the increased risk of cancer in inflammatory bowel disease is confined to colorectal cancer. In Crohn's disease 12 cases of colorectal cancer were observed (SIR 2.5, 95% CI 1.3 to 4.3). The increased risk was confined to those with colonic involvement and young age at diagnosis. In patients with colonic involvement and younger than age 30 years at diagnosis, the SIR was 20.9 (95% CI 6.8 to 48.7) versus 2.2 for those older than 30 years at diagnosis (95% CI 0.6 to 5.7). In ulcerative colitis 91 cases of colorectal cancer were observed with an SIR of 5.7 (95% CI 4.6 to 7.0). Extensive disease and young age at diagnosis were independent risk factors. Pancolitis at diagnosis resulted in an SIR of 14.8 (95% CI 11.4 to 18.9), 2.8 in left-sided colitis (95% CI 1.6 to 4.4) and 1.7 in proctitis (95% CI 0.8 to 3.2). There is great variation in the risk estimates in different studies worldwide. Different treatment strategies could be an explanation, a hypothesis that was substantiated in a study of 102 cases of colorectal cancer among patients with ulcerative colitis compared with 196 controls. Pharmacological therapy with sulfasalazine entailed a strong protective effect against colorectal cancer (relative risk of 0.34, 95% CI 0.190 to 0.62).

scholarly journals P275 Biological therapies for patients with Crohn’s disease: More options mean less surgical interventions

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S288-S289
Author(s):  
Y F Chin ◽  
O PUJJI ◽  
B Wilkinson ◽  
S Mohan ◽  
M Nnaji ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bowel Disease ◽  
Strong Positive Correlation ◽  
Biological Therapies ◽  
Free Survival ◽  
Positive Correlation ◽  
Surgical Data ◽  
Inflammatory Bowel

Abstract Background The advent of biologic therapy and their acceptance into mainstream use for the medical management of patients with inflammatory bowel disease (IBD) has transformed the landscape of treatment for this condition. It has particularly become a mainstay in the treatment of fistulating or perianal Crohn’s Disease (CD). Data have shown that overall, 70% of patients will require surgical resections for CD. Consequently, questions have endured regarding the effect of biologic medications on the overall treatment course of CD patients. Our aim is to identify the efficacy of biologics by measuring surgical free survival. We subcategorised the period into 3 categories, including periods less than a year 1–5 years and >5 years and comparing these with the number of biologics they required to be switched either due to side effects or loss of medical response. Methods A retrospective analysis of prospectively collected data was correlated with the clinical coding department, inflammatory bowel disease and surgical databases. Patients receiving biological therapies were identified (Infliximab, Adalimumab, Vedolizumab, Ustekinumab, Certolizumab). Demographics, clinical and surgical data were analysed. Results Sixty-six patients were included in our analysis. Male to female ratio is 1 to 1.07, age range was 18–77, median age 41 (SD:17.46) years old. Twenty-five patients had ileocaecal resection, 17 had hemi and segmental colectomy, 7 had small bowel resection, 10 had subtotal colectomy and 7 had panproctocolectomy. Refractory to one biologic does not indicate biological failure; number of biologics switched and surgical free survival were compared. We have utilised the Spearman correlation coefficient for nominal analysis which gave us a coefficient of +0.725, p = 0.00. This indicates that both factors have a strong positive correlation between numbers of biologics patients used against period required for surgical management. Conclusion In the current era of biological therapies, with a breadth of choice of therapeutic agents, our data has a positive correlation between the number of biological agents used and surgery-free survival for patients with Crohn’s disease. A multidisciplinary approach to the management of these patients should be personalised, and suitability to each biological agent should be considered in addition to close surgical observation.

P1789DE NOVO INFLAMMATORY BOWEL DISEASE AFTER KIDNEY TRANSPLANTATION - REPORT OF THREE CASES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Katarina Obrencevic ◽  
Marijana Petroviä‡ ◽  
Neven Vavic ◽  
Stanko Petrovic ◽  
Ivana Tufegdzic ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Kidney Transplantation ◽  
Crohn's Disease ◽  
Renal Disease ◽  
Immunosuppressive Therapy ◽  
Bowel Disease ◽  
De Novo ◽  
Inflammatory Bowel

Abstract Background and Aims Inflammatory bowel disease (IBD) are not common after kidney transplantation. Development of IBD in the patient on immunosuppression is unexpected, because IBD is believed to be the result of inappropriate and ongoing activation of the mucosal immune system and immunosuppressive drugs are used in the treatment of IBD. The aim of our study was to evaluate the occurrence of de novo IBD, ulcerative colitis and Crohn’s disease, in the patients who received kidney transplant in our hospital, the time after transplantation and the immunosuppression therapy when diagnosis was made. Method We used an electronic medical archival system to identify the patients with IBD. Between 1996 and 2018 a total of 462 kidney transplantations were done in Military Medical Academy. Analysis in this study included 400 patients who were regulary controlled in our hospital. Demographic data and clinical findings including age, sex, primary renal disease, type of kidney donor, and immunosuppressive therapy were evaluated. The time of the occurrance of the IBD after transplantation, the colonoscopy and pathologic findings were also noted. Results de novo IBD was observed in three patients 19, 11 and 7 years after kidney transplantation respectively. In all patients end-stage renal disease was due to chronic glomerulonephritis without histology verification. Family history was negative in all. They were male, age 40, 42 i 47 years respectively when diagnosis was made. Their immunosuppressive regimen included prednisone, mycophenolate mofetil (MMF) and tacrolimus with a trough level between 5 and 7 ng/ml. They all developed constitutional symptoms with significant weight loss and fever, abdominal pain and cramps, diarrhoea which was in one case bloody. Infectious and other etiology was excluded. Colonoscopy showed ulcerative colitis in two patients and Crohn’s disease in one. The patients with ulcerative colitis responded on maintenance therapy combined with 5-aminosalicylic acid, but one of them had common flare-ups with mild clinical picture. The patient with Crohn’s disease was successfully treated with azathioprine instead of MMF with high-dose steroids. Conclusion We concluded that new onset of IBD can develop after kidney transplantation despite use of immunosuppressive therapy. It should be considered in all transplanted patients who develop gastrointestinal complaints. The future studies could answer why the immunosuppressive therapy is not effective for IBD in these group of patients.

scholarly journals Lifestyle Issues in Inflammatory Bowel Disease – Smoking

1994 ◽  
Vol 8 (7) ◽  
pp. 422-427 ◽  
Author(s):  
Cecilia Benoni
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Protective Effect ◽  
Bowel Disease ◽  
Clinical Course ◽  
Clinical Effects ◽  
Increased Risk ◽  
Inflammatory Bowel

During the pa t decade, smoking habit has been identified as a major exogenous factor in inflammatory bowel disease (IBD). It is associated not only with the development of the disease but al o with the clinical course in established disease. IBD combines absolute opposites as smoking is associated with Crohn’s disease and nonsmoking or former smoking with ulcerative colitis. The first reports of a negative association between smoking and ulcerative colitis were based on independent, clinical observations; from those studies a positive association was found between smoking and Crohn’s disease. Epidemiological studies that followed consistently showed that smokers have a reduced risk of ulcerative colitis and an increased risk of Crohn’s disease and that exsmokers have an increased risk of ulcerative colitis. In ulcerative colitis, but not in Crohn’s disease, a dose-response pattern has been demonstrated. Changes in clinical course, in disease severity and extension, and in recurrence rate indicate substantial clinical effects of smoking with a protective effect of smoking in ulcerative colitis and an aggravating effect in Crohn’s disease. There are also indications of smoking’s effects on changes in IBD epidemiology and sex distribution. The biological explanation to the finding is unknown. Smoking may aggravate Crohn’s disease by vascular effects. Theories on the protective effect in ulcerative colitis include effects on immune and inflammatory response, on mucus and on intestinal permeability. Possibly, beneficial effects in ulcerative colitis are exerted by nicotine but further studies are needed. Due to overall negative effects of smoking, IBD patients should not smoke. It seems, however, reasonable to give individual advice in patients with ulcerative colitis who have experienced a beneficial effect of ·making considering both current health status and life situation.

scholarly journals Risk of Inflammatory Bowel Disease in Patients with Chronic Myeloproliferative Neoplasms: A Danish Nationwide Cohort Study

Cancers ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2700
Author(s):  
Marie Bak ◽  
Tine Jess ◽  
Esben Meulengracht Flachs ◽  
Ann-Dorthe Zwisler ◽  
Knud Juel ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Cohort Study ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bowel Disease ◽  
Myeloproliferative Neoplasms ◽  
Increased Risk ◽  
Hematological Cancers ◽  
Inflammatory Bowel

An association between hematological cancers and inflammatory bowel disease (IBD) has previously been suggested, but the risk of IBD in patients with myeloproliferative neoplasms (MPNs) is unknown. We conducted a nationwide population-based cohort study using Danish registries, to estimate the risk of IBD in individuals diagnosed with essential thrombocythemia, polycythemia vera, myelofibrosis or unclassifiable MPN during 1994–2013. MPN patients were matched 1:10 with sex- and age-matched comparisons. Everyone was followed until a diagnosis of IBD, death/emigration, or 31 December 2013. The risk of IBD overall and according to MPN subtype was calculated using Cox regression and presented as hazard ratios (HRs) with 95% confidence intervals (CI). Of 8207 MPN patients followed for 45,232 person-years, 80 were diagnosed with IBD (61 ulcerative colitis, 19 Crohn’s disease). The rate of IBD per 1000 person-years was 1.8 (95% CI:1.4–2.2) in patients vs. 0.8 (95% CI:0.7–0.8) in comparisons, and the absolute 10-year risk of IBD was 0.8% (95% CI:0.6–1.0) in patients vs. 0.4% (95% CI:0.4–0.5) in comparisons. The HR of IBD was 2.4 (95% CI:2.1–2.9) with similar HRs for ulcerative colitis and Crohn’s disease. MPN subtype risks varied from 2.1 (95% CI:1.6–2.7) to 2.8 (95% CI:2.1–3.7). Our unselected cohort study showed a more than 2-fold increased risk of IBD in MPN patients.

scholarly journals Genetic polymorphism of HLA-G gene (G*01:03, G*01:04, and G*01:05N) in Iraqi patients with inflammatory bowel disease (ulcerative colitis and Crohn’s disease)

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sarah S. Abdul-Hussein ◽  
Ekhlass N. Ali ◽  
Neihaya H. Zaki ◽  
Ali H. Ad’hiah
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bowel Disease ◽  
Human Leukocyte ◽  
Leukocyte Antigen ◽  
Increased Risk ◽  
Soluble Hla ◽  
Inflammatory Bowel

Abstract Background Human leukocyte antigen-G (HLA-G) has been proposed to influence susceptibility to inflammatory bowel disease (IBD). Therefore, the genetic association between HLA-G alleles and two clinical phenotypes of IBD (ulcerative colitis [UC] and Crohn’s disease [CD]) was evaluated in Iraqi patients. A case-control study was performed on 50 UC and 50 CD patients and 100 healthy controls (HC). Three HLA-G alleles (G*01:03, G*01:04, and G*01:05N) were determined using sequence-specific polymerase chain reaction assay followed by product digestion with restriction endonucleases (Hinf-I, BseR-I, and PpuM-I, respectively). Results The G*01:03 allele was not detected in IBD patients (UC and CD) or HC, while G*01:04 and G*01:05N alleles showed polymorphic frequencies. The allele G*01:04 was significantly associated with susceptibility to UC (odds ratio [OR] = 2.55; 95% confidence interval [CI] = 1.27–5.13; corrected probability [pc] = 0.018) and CD (OR = 4.45; 95% CI = 2.11–9.41; pc < 0.001). The allele G*01:05N was also associated with increased risk of UC (OR = 4.17; 95% CI = 1.32–13.21; pc = 0.032) and CD (OR = 4.75; 95% CI = 1.53–14.78; pc = 0.014). These associations were more pronounced in IBD (UC + CD), and a significantly increased risk for IBD was found with the alleles G*01:04 (OR = 3.32; 95% CI = 1.86–5.95; pc < 0.001) and G*01:05N (OR = 4.46; 95% CI = 1.59–12.47; pc = 0.008). A stratification of IBD patients according to some demographic and clinical characteristics revealed that frequencies of both alleles showed no significant differences between the subgroups of patients in each stratum. Soluble HLA-G was not influenced by HLA-G alleles in patients or HC. UC was an exception, and the presence of G*01:04 allele was associated with a significantly higher mean of soluble HLA-G compared to patients without the allele (189.6 ± 24.0 vs. 168.6 ± 27.2 ng/mL; p = 0.033). Conclusion This study indicated that HLA-G*01:04 and HLA-G*01:05N alleles may influence susceptibility to UC and CD in Iraqi patients.

scholarly journals P239 Elderly-onset inflammatory bowel disease is associated with higher risks of infections, cancers and hospitalisation: Results from a territory-wide Hong Kong IBD registry

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S262-S264
Author(s):  
J W Y Mak ◽  
L T C Ho ◽  
K Wong ◽  
T Y Cheng ◽  
T C F Yip ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Hong Kong ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bowel Disease ◽  
Cancer Development ◽  
Increased Risk ◽  
Elderly Onset ◽  
Inflammatory Bowel

Abstract Background Incidence of elderly-onset inflammatory bowel disease (IBD), defined as age ≥ 60 at diagnosis, is increasing rapidly worldwide. We aimed to compare the clinical characteristics and natural history of elderly onset IBD patients to non-elderly onset IBD patients. Methods Patients with a confirmed diagnosis of IBD from 1981 to 2016 were identified from a territory-wide Hong Kong IBD registry involving 13 hospitals. Demographics, comorbidities, clinical features and outcomes of elderly-onset IBD patients were compared with non-elderly onset IBD patients. Results Total 2413 patients were identified, of whom 270 (11.2%) had elderly-onset IBD during 21805 person-years follow-up. Median follow-up duration was 111 months (Interquartile range [IQR]: 68–165 months). The ratio of ulcerative colitis (UC): Crohn’s disease (CD) was higher in elderly-onset IBD than non-elderly onset IBD patients. (3.82:1 vs. 1.39:1; p &lt; 0.001). Elderly-onset Crohn’s disease (CD) had less perianal involvement (5.4% vs. 25.4%; p &lt; .001) but more stricturing phenotype (32.1% vs. 20.5%; p = 0.04) than non-elderly onset. There was no difference in the rate of cumulative use of biologics (p = 0.49), but significantly lower use of immunosuppressants in elderly-onset IBD patients (p = 0.001). Cumulative risk of IBD-related surgeries was similar (p = 0.89). Elderly-onset IBD was associated with higher risks of cytomegalovirus colitis (Odds ratio [OR]: 3.07; 95% Confidence Interval (CI) 1.92–4.89; p &lt; 0.001); herpes zoster infections (OR: 2.42; 95% CI: 1.22–4.80; p = 0.12) and all cancer development (Hazard ratio: 2.97; 95% CI: 1.84–4.79; p &lt; 0.001). Elderly-onset IBD was also associated with increased number of overall hospitalisation (OR: 1.14; 95% CI 1.09–1.20; p &lt; 0.001), increased number of infections-related hospitalisation (OR: 1.87; 95% CI 1.47–2.38; p &lt; 0.001) and longer hospitalisation (OR: 1.004; 95% CI: 1.001- 1.007; p = 0.007) compared with non-elderly onset IBD. Conclusion Elderly-onset IBD has less perianal CD. However, they have significantly more comorbidities and are associated with increased risk of infections, cancer development and increased and prolonged hospitalisations. Specific therapeutic strategies are needed in this special group of patients.

scholarly journals Thiopurine monotherapy is effective in ulcerative colitis but significantly less so in Crohn’s disease: long-term outcomes for 11 928 patients in the UK inflammatory bowel disease bioresource

Gut ◽  
2020 ◽  
pp. gutjnl-2019-320185 ◽  
Author(s):  
Evangelos Stournaras ◽  
Wendi Qian ◽  
Apostolos Pappas ◽  
You Yi Hong ◽  
Rasha Shawky ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bowel Disease ◽  
Increased Risk ◽  
Long Term Treatment ◽  
Inflammatory Bowel ◽  
The Uk

ObjectiveThiopurines are widely used as maintenance therapy in inflammatory bowel disease (IBD) but the evidence base for their use is sparse and their role increasingly questioned. Using the largest series reported to date, we assessed the long-term effectiveness of thiopurines in ulcerative colitis (UC) and Crohn’s disease (CD), including their impact on need for surgery.DesignOutcomes were assessed in 11 928 patients (4968 UC, 6960 CD) in the UK IBD BioResource initiated on thiopurine monotherapy with the intention of maintaining medically induced remission. Effectiveness was assessed retrospectively using patient-level data and a definition that required avoidance of escalation to biological therapy or surgery while on thiopurines. Analyses included overall effectiveness, time-to-event analysis for treatment escalation and comparison of surgery rates in patients tolerant or intolerant of thiopurines.ResultsUsing 68 132 patient-years of exposure, thiopurine monotherapy appeared effective for the duration of treatment in 2617/4968 (52.7%) patients with UC compared with 2378/6960 (34.2%) patients with CD (p<0.0001). This difference was corroborated in a multivariable analysis: after adjusting for variables including treatment era, thiopurine monotherapy was less effective in CD than UC (OR 0.47, 95% CI 0.43 to 0.51, p<0.0001). Thiopurine intolerance was associated with increased risk of surgery in UC (HR 2.44, p<0.0001); with a more modest impact on need for surgery in CD (HR=1.23, p=0.0015).ConclusionThiopurine monotherapy is an effective long-term treatment for UC but significantly less effective in CD.

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