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Inicio Gastroenterología y Hepatología Azatioprina y mesalazina en la prevención de la recurrencia posquirúrgica en l...
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Vol. 27. Núm. 10.
Páginas 563-567 (Enero 2004)
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Vol. 27. Núm. 10.
Páginas 563-567 (Enero 2004)
DOI: 10.1016/S0210-5705(03)70533-0
Acceso a texto completo
Azatioprina y mesalazina en la prevención de la recurrencia posquirúrgica en la enfermedad de Crohn: estudio retrospectivo
Azathioprine and mesalazine in the prevention of postsurgical recurrence of crohn's disease: a retrospective study
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E. Domènecha,
Autor para correspondencia
domenech@ns.hugtip.scs.es

Correspondencia: Dr. E. Domènech Morral. Servicio de Aparato Digestivo. 5.a planta, edificio general. Hospital Universitari Germans Trias i Pujol. Carretera del Canyet, s/n. 08916 Badalona. Barcelona. España.
, L. Scalaa, I. Bernala, E. García-Planellaa, A. Casalotsb, M. Piñolc, M. Esteve-Comasd, E. Cabréa, J. Boixa, M.A. Gassulla
a Servicio de Aparato Digestivo. Hospital Universitari Germans Trias i Pujol. Badalona
b Servicio de Anatomía Patológica. Hospital Universitari Germans Trias i Pujol. Badalona
c Servicio de Cirugía General. Hospital Universitari Germans Trias i Pujol. Badalona. Barcelona
d Servicio de Aparato Digestivo. Hospital Mútua de Terrassa. Terrassa. Barcelona. España
Información del artículo
Resumen
Bibliografía
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Estadísticas
Objetivos

La resección quirúrgica todavía es un pilar fundamental en el tratamiento de la enfermedad de Crohn (EC); sin embargo, la recurrencia es la norma. El objetivo del presente estudio es evaluar la aparición de recurrencia de EC en una serie de pacientes a quienes se practicó una resección quirúrgica, tratados posteriormente con azatioprina (AZA) o mesalazina (5-ASA), e identificar los factores asociados a la recurrencia.

Métodos

Se revisaron las historias clínicas de los pacientes con EC, a quienes se practicó una resección intestinal, durante un período de 4 años. Sólo fueron incluidos en el estudio los que recibieron AZA o 5-ASA como profilaxis de la recurrencia.

Resultados

Se incluyeron 33 pacientes tratados con AZA y 16 con 5-ASA. Se constató una recurrencia endoscópica en el 8,6 y el 87,5% de los pacientes del grupo AZA y 5-ASA, respectivamente (p < 0,001). El 31,2% de los pacientes del grupo 5-ASA, frente a ninguno del grupo AZA, desarrollaron una recurrencia clínica (p = 0,004). La probabilidad acumulada de recurrencia, tanto clínica como endoscópica, fue significativamente inferior en el grupo AZA (p = 0,0025 y p = 0,005, respectivamente). La anastomosis términoterminal y el tratamiento con 5-ASA se asociaron con un mayor riesgo de recurrencia endoscópica, y sólo se asoció el tratamiento con 5-ASA a la recurrencia clínica.

Conclusión

AZA parece ser más eficaz que 5-ASA en la prevención de la recurrencia endoscópica posquirúrgica en la EC. Son necesarios estudios prospectivos con seguimiento a largo plazo para establecer la verdadera utilidad de AZA en esta situación clínica.

Objectives

Surgical resection is still a mainstay of the treatment of Crohn's disease (CD). However, recurrence is the rule. The aim of the present study was to evaluate CD recurrence in a series of patients who underwent surgical resection with subsequent treatment with azathioprine (AZA) or mesalazine (5-ASA) and to identify the factors associated with recurrence.

Methods

The medical records of patients with CD who underwent bowel resection during a 4-year period were reviewed. Only patients who received AZA or 5-ASA as prophylaxis for recurrence were included.

Results

Thirty-three patients treated with AZA and 16 treated with 5-ASA were included. Endoscopic recurrence was found in 8.6% of the AZA group and in 87.5% of the 5-ASA group (p < 0.001). Clinical recurrence occurred in 31.2% of patients in the 5-ASA group and in none in the AZA group (p = 0.004). The accumulated probability of both clinical and endoscopic recurrence was significantly lower in the AZA group (p = 0.0025 and p = 0.005, respectively). Factors associated with a greater risk of endoscopic recurrence were terminoterminal anastomosis and 5-ASA treatment. The only factor associated with clinical recurrence was 5-ASA treatment.

Conclusion

AZA seems to be more effective than 5-ASA in the prevention of postsurgical endoscopic recurrence of CD. Prospective studies with long-term follow-up are required to establish the true utility of AZA in the prophylaxis of CD recurrence.

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