NEW YORK (Reuters Health) - The medications a person takes to combat Crohn's influences their risk of death, according to findings in the journal Gastroenterology.
Crohn's disease and ulcerative colitis are classified as inflammatory bowel diseases (IBD). The body's immune cells attack the bowel walls in both diseases. With Crohn's disease, the damage is usually to the small intestines, but it can occur anywhere in the gastrointestinal tract from the mouth to the anus. Medications are used to treat the disease, but surgery is often required when severe disease flare-ups constrict the bowel.
"Despite improved therapy, IBD patients, particularly those with Crohn's disease, continue to face an increased risk of death," lead author Dr. Lisa J. Herrinton, of Kaiser Permanente Northern California, Oakland, told Reuters Health. "The risk for Crohn's disease is increased not only for gastrointestinal disease-related causes, but also for respiratory disease and infections."
In the current study, Herrinton and colleagues examined the IBD death risk in a group of Kaiser Permanente members and looked at the medications they used to treat their disease. A total of 9,032 subjects who had been diagnosed with an IBD during 1996 to 2002 were included in the study.
Of the 9,032 patients, 3,241 had a diagnosis of Crohn's disease, 5,238 had a diagnosis of ulcerative colitis, and 553 were diagnosed with both. The death risk was increased in patients with Crohn's compared with health plan members without IBD. By contrast, the risk was not increased in those with ulcerative colitis.
"The specific causes of death related to Crohn's disease...were infections, respiratory diseases, digestive disease and liver disease," Herrinton said. "These causes represented 29 percent of all deaths."
"With ulcerative colitis, although the overall risk of death was not increased, we nonetheless found a nearly fourfold increased risk of death from digestive disease, with digestive disease representing about 12 percent of all deaths."
Overall, 88 percent of patients with Crohn's disease or ulcerative colitis used at least one IBD medication during the study period.
Overall, using any medication to treat Crohn's disease cut the risk of death by 10 percent. However, the effect varied with individual medications. For instance, use of aminosalicylate, a popular drug for the disease, reduced the risk by 30 percent, whereas use of drugs that altered the immune response increased the risk by 30 percent.
"More detailed exploration of the constellation of causes leading to death is warranted," Herrinton said. "The most important of these are related to the disease, its therapy, and care processes."
SOURCE: Gastroenterology, December 2007.
Reuters Health
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