Prevention of Multiple Operations in Crohn's Disease Patients Using Immunosuppressive Drugs

Crohn's disease is a chronic recurrent inflammatory disorder of the gastro-intestinal (GI) tract that affects 500,000 individuals in the United States . An immune system defect in clearing debris that penetrates the mucosal layer of the GI tract is thought to trigger Crohn's. Symptoms of Crohn's include abdominal pain, frequent diarrhea and loss of weight. Crohn's can be severe enough in some instances to warrant surgery to remove a portion of damaged GI tract.

Approximately 80% of Crohn's patients will require surgery at some point in the disease course. Additionally, 36 to 57% of those patients who have surgery will experience a Crohn's reoccurrence that necessitates an additional surgical procedure. Surgery is a burden on both the patient and the health care system. A recent retrospective study in The American Journal of Gastroenterology assessed the use of the immunosuppressive agents azathioprine and 6-mercaptopurine in preventing surgical reoccurrence.

The authors used data from 563 Crohn's disease patients from a previous study, of which 326 required surgery and 151 required re-operation. Patients were randomized notably on demographic information, Crohn's disease duration and treatment history. Re-operation rates for patients receiving the immunosuppressive agents mentioned above over several periods of different length were calculated.

Overall rates of re-operation were 53.9% in patients not treated with azathioprine or 6-mercaptopurine and 38.5% in the treated group after the first operation, a difference that was statistically different. Stratifying the treated group by the duration of drug treatment suggests that the optimal duration of therapy after surgery is 36 months or greater for optimal benefit. Patients treated for greater than 36 months had a re-operation rate of 26.8%, while those treated less than 3 months had a rate nearly identical to the untreated group.

The authors work is significant because it suggests that long-term treatment with immunosuppressive agents, such as azathioprine or 6-mercaptopurne, can reduce the rate of reoperation in Crohn's disease patients. This is beneficial to the patient to prevent the trauma of surgery and to lower overall burden of a chronic disease, such as Crohn's disease, on the health care system.

References:

Lichtenstein, G.R. et, al. Management of Crohn's disease in adults. Am J Gastroenterol. 2009: 104(2): p. 465-83.

Papay, P. et, al. The Impact of Thiopurines on the Risk of Surgical Recurrence in Patients With Crohn ' s Disease After First Intestinal Surgery. Am J Gastroenterol. advance online publication, 15 December 2009