Crohn's Rx May Lead to Less Surgery

Crohns disease treatment with thiopurines reduced need for surgery in first five years after diagnosis

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Crohn's disease can cause unpleasant symptoms, and for some patients, surgery may be needed. But one common medication could lower the risk of going under the knife.

A new study focused on the use of thiopurines in patients with Crohn's disease, an inflammatory bowel condition.

The researchers found that Crohn's disease patients who were prescribed thiopurines for at least six months had a reduced risk of surgery for their condition within the first five years.

"Try a food diary to track foods that irritate your system."

In Crohn's disease, the lining of the digestive tract becomes inflamed. Symptoms can range in severity and include issues like diarrhea, abdominal pain, weight loss, bowel obstruction and ulcers.

According to the authors of this study, who were led by Sukhdev Chatu, MD, of the Department of Gastroenterology at St George’s University Hospital in London, at least half of Crohn's disease patients will need surgery within 10 years of developing the disease, and an estimated 70 to 80 percent will need surgery at some point during their life.

Some have suggested using thiopurines to lower the risk of surgery for Crohn's disease patients, though there is still much to learn about this potential association.

Thiopurines are a type of medication sometimes used to treat auto-immune conditions like Crohn's disease. According to the Mayo Clinic, these medications, which include azathioprine (brand name Imuran) and mercaptopurine (Purinethol), aim to reduce inflammation by suppressing the immune system's response.

To explore the relationship between thiopurines and surgery for Crohn's disease, Dr. Chatu and colleagues utilized the Clinical Practice Research Data link, a large survey of 8 percent of the United Kingdom's population.

The researchers identified 5,640 patients with Crohn's disease during the years 1989 and 2005. The average age of the patients at the time of their diagnosis was 32 years old.

The researchers noted if patients were on thiopurines prior to any surgery for Crohn's, how long they used the medication and incidences of surgery during five years of follow-up after diagnosis.

The main surgery examined was intestinal resection, in which a part of the intestines is removed. In total, 559 (11 percent) of the patients had at least one such surgery within five years of being diagnosed with Crohn's disease.

Overall, 25 percent of the participants had at least one thiopurine prescription. As the study went on, the researchers found that the amount of patients using thiopurines increased and the likelihood of surgery decreased.

Dr. Chatu and colleagues found that patients who had at least six months of thiopurine use had a 44 percent reduced risk of surgery in the first five years after diagnosis compared to those who did not use thiopurines for at least six months. Patients who had at least 12 months of thiopurine use had a 69 percent reduced risk.

The researchers found no major differences between thiopurine treatment that started earlier (less than 12 months after diagnosis) and thiopurine treatment that started later.

"Over the past 20 years, [thiopurine] use has doubled, whereas intestinal surgery has fallen by one-third among the UK population of Crohn's patients," Dr. Chatu and colleagues wrote.

Further research is needed to confirm these findings.

It is important to note that these medications might come with side effects. According to the Mayo Clinic, immunosuppressants like thiopurines can cause lowered resistance to infections, bone marrow suppression and other side effects.

This study was published January 28 in The American Journal of Gastroenterology. No conflicts of interest were reported.

Review Date: 
January 29, 2014
Last Updated:
January 31, 2014