Nodular regenerative hyperplasia in patients with inflammatory bowel disease treated with azathioprine.
OBJECTIVE
To assess the characteristics and clinical course of nodular regenerative hyperplasia (NRH) in patients with inflammatory bowel disease treated with azathioprine, so as to estimate the frequency of this complication and search for risk factors.


METHODS
Cases were identified through a systematic survey of patients followed at 11 centres. At one centre, the cumulative risk of NRH was estimated and a case-control study was undertaken to identify risk factors.


RESULTS
37 cases of NRH (30 male, 7 female) were identified between 1994 and 2005. The median dose of azathioprine was 2 mg/kg/d (range 1.5 to 3.0). The median time between the start of azathioprine and the diagnosis of NRH was 48 months (range 6 to 187). After a median follow up period of 16 months (range 1 to 138), 14 patients developed complications of portal hypertension. Using multivariate analysis, male sex and stricturing behaviour were the two risk factors associated with NRH in patients treated with azathioprine. The cumulative risk calculated from the database (one centre) was 0.5% at 5 years (95% confidence interval, 0.11 to 0.89) and 1.25% at 10 years (0.29 to 2.21).


CONCLUSIONS
NRH is a rare but potentially severe complication of azathioprine in patients with inflammatory bowel disease. Clinicians should be aware of this complication, and should monitor liver function tests and platelet counts closely in their patients.
Vernier-Massouille
G
G
Department of Hepato-Gastroenterology, Hôpital Claude Huriez, CH et U de Lille, France.
Cosnes
J
J
Lemann
M
M
Marteau
P
P
Reinisch
W
W
Laharie
D
D
Cadiot
G
G
Bouhnik
Y
Y
De Vos
M
M
Boureille
A
A
Duclos
B
B
Seksik
P
P
Mary
J-Y
JY
Colombel
J-F
JF
D000293:Adolescent; D000328:Adult; D001379:Azathioprine / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D004812:Epidemiologic Methods; D005060:Europe / Q000453:epidemiology; D005260:Female; D020518:Focal Nodular Hyperplasia / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D006975:Hypertension, Portal / Q000139:chemically induced; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged
D007166:Immunosuppressive Agents; D001379:Azathioprine