Introduction of 6-mercaptopurine in Crohn's disease patients during the perioperative period: a preliminary evaluation of recurrence of disease.
BACKGROUND
Recurrence of Crohn's disease after surgery is a common occurrence, pointing to the need for a strategy to prevent recurrent disease. We report the postoperative course of 10 patients who required intestinal resections for complications related to Crohn's disease.


METHODS
All patients had a Pediatric Crohn's Disease Activity Index score of 10 or greater. Among these patients, 5 began treatment with 6-mercaptopurine in the perioperative period. All 10 had received various combinations of prednisone and salicylate compounds. Patients who were given 6-mercaptopurine did not discontinue the medication until 2 years after the surgery.


RESULTS
To date, none of the five patients who were placed on 6-mercaptopurine have had recurrence of their Crohn's disease (mean disease-free period 32.6 +/- 18.4 months). Among those five patients not receiving 6-mercaptopurine there have been three relapses (mean time to relapse 3.7 +/- 1.2 months). Log-rank sum analyses of Kaplan-Meier survival curves show benefit to patients receiving 6-mercaptopurine in preventing relapses after intestinal resection (p < 0.05).


CONCLUSIONS
Although the underlying pathophysiologic reasons leading to the high relapse rate after intestinal surgery in Crohn's disease are unknown, we conclude that treatment with 6-mercaptopurine in the perioperative period may be warranted to help prevent the recurrence of Crohn's disease after surgery.
Kader
H A
HA
Department of Pediatrics, University of Nebraska Medical Center, Creighton University and Children's Hospital, Omaha, USA.
Raynor
S C
SC
Young
R
R
Kaufman
S S
SS
Vanderhoof
J
J
Ruby
E I
EI
Mack
D R
DR
D000293:Adolescent; D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D002648:Child; D003424:Crohn Disease / Q000503:physiopathology / Q000517:prevention & control* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007422:Intestines / Q000601:surgery; D015122:Mercaptopurine / Q000627:therapeutic use*; D011184:Postoperative Period; D012008:Recurrence; D016019:Survival Analysis; D013997:Time Factors
D000964:Antimetabolites, Antineoplastic; D015122:Mercaptopurine