title: Inflammatory bowel diseases and primary sclerosing cholangitis: hepatic and pancreatic side effects due to azathioprine.
abstract: OBJECTIVE
  In up to 80% of cases primary sclerosing cholangitis (PSC) is associated with inflammatory bowel diseases (IBD). The efficacy of azathioprine (AZA), in the maintenance of remission of IBD has been suggested by several studies. However, AZA tends to exter varied well-known toxicity. Since the rate of hepato-pancreatic side-effects in patients with IBD and PSC is still unclear, we investigated this issue.
  
  
  METHODS
  Consecutive subjects who underwent Outpatient Clinic admission for both IBD and PSC were included. Both conditions were diagnosed according to International Guidelines.
  
  
  RESULTS
  Data of 43 patients were elaborated. Twelve of them underwent therapy with AZA. Five (41.7%) presented hepatic (n=4) or pancreatic toxicity. Eighty percent of the patients with hepato-pancreatic reactions versus 28.6% of those without (p < 0.001) were males, with 60% affected by ulcerative colitis and 40% by Crohn's disease versus 57% and 43%, respectively. Forty percent of patients with reactions versus 43% of those without needed an operation for IBD, and the same percentage underwent orthotopic liver transplantation, with a 100% versus 66.7% (p < 0.001) need of second transplantation. Colonic neoplasia (20%) was detected only in the former group while cholangiocarcinoma (28.6%) only in the latter.
  
  
  CONCLUSIONS
  The occurrence of hepato-pancreatic reactions from AZA in our caseload is higher (41.7%) compared to that reported in literature (4%). Therefore, the presence of PSC, in association to IBD, may strongly affect AZA tolerability compared to presence of IBD only.
authors: Department of Gastroenterology and Hepatology, Molinette Hospital, Torino, Italy.
authors: F
authors: F
authors: Pallavicino
authors: R
authors: R
authors: Pellicano
authors: S
authors: S
authors: Reggiani
authors: D
authors: D
authors: Simondi
authors: C
authors: C
authors: Sguazzini
authors: A G
authors: AG
authors: Bonagura
authors: F
authors: F
authors: Cisarò
authors: M
authors: M
authors: Rizzetto
authors: M
authors: M
authors: Astegiano
mesh_terms: D000293:Adolescent; D000328:Adult; D001379:Azathioprine / Q000009:adverse effects*; D002648:Child; D015209:Cholangitis, Sclerosing / Q000150:complications*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D008099:Liver / Q000187:drug effects*; D016031:Liver Transplantation; D008297:Male; D010179:Pancreas / Q000187:drug effects*; D012189:Retrospective Studies
chemical_list: D001379:Azathioprine