engleski

Gastric pathology in Crohn's disease patients treated with azathioprine in tertiary IBD Centre

INTRODUCTION/OBJECTIVES: There are dilemmas in the field of gastric pathology in patients (pts) with inflammatory bowel disease (IBD) but recent reports indicate that gastric involvement in IBD pts is not as rare as previously thought. Since the azathioprine is one of the most important immunosupressives in the therapy of Crohn's disease (CD) the aim of the study was to evaluate the potential association of gastric pathology and treatment with azathioprine. AIMS & Methods: We evaluated histologically the presence of chronic gastritis, mucosal dysplasia, H. pylori infection and epitheloid granulomas in 29 azathioprine treated pts (AZA group) and 20 non-azathioprine treated pts (non-AZA group), treated with other non-immunosupressive drugs (mesalamine, corticosteroid). Patients were hospitalized in tertiary IBD center and underwent upper endoscopy with multiple biopsies during their hospital evaluation. RESULTS: 49 pts with CD with no previously registered upper gastrointestinal (GI) lesions were included in the study. AZA CD group included 29 pts (mean age 33, 3 yrs) and non-AZA group 20 pts (mean age 41.43 yrs). The characteristics of AZA group according to Vienna classification were as followed: non-penetrating non-stricturing (B1) 18 pts (62.1%), stricturing (B2) 8 pts (27.6%), penetrating (B3) 3 pts (10.3%). Ileocolonic localization (L3) had 15 pts (51.7%), colonic localization (L2) 5 pts (17.2%) and 9 pts (31%) ileal disease (L1). There was no statistical difference regarding phenotype and disease localization characteristics in non-AZA group. Chronic gastritis was detected in 20 AZA pts (69%) and in 14 (70%) non-AZA pts (p=1.00 Fischer). H. pylori infection was found in 1 AZA (3.4%) and 2 (10%) non-AZA pts (p=0.559). Epithelial dysplasia was not found iz AZA group, meanwhile 1 patient in non-AZA group (5%) had histologically confirmed dysplasia (p=0.408). Epithelial granulomas of upper GI tract was found in 2 AZA pts (6.9%), meanwhile non-AZA pts did not have epitheloid granulomas (p=0.508). CONCLUSION: We concluded that azathioprine treatment in CD patients did not increase the prevalence of chronic gastritis, H. pylori infection, dysplasia and epitheloid granulomas in gastric mucosa. For a more detailed analysis regarding the causes of this observation it is necessary to conduct a research in a larger cohort of patients.

gastric; Crohn's disease; azathioprine

nije evidentirano