title: Azathioprine is more effective than mesalazine at preventing recurrent bowel obstruction in patients with ileocecal Crohn's disease.
abstract: BACKGROUND
  Patients with subocclusive Crohn's disease (CD) who received azathioprine (AZA) therapy had lower re-hospitalization rates due to all causes and for surgical management of CD compared to those treated with mesalazine during a 3-year period. We investigated whether AZA also was effective for prevention of recurrent bowel obstruction.
  
  
  METHODS
  Rates of recurrent bowel occlusion were compared between patients treated with AZA and those treated with mesalazine. We assessed the time interval-off intestinal obstruction as well as the occlusion-free survival for both groups.
  
  
  RESULTS
  There was a significantly lower cumulative rate of patients with recurrent subocclusion in the AZA group (56%) compared with the mesalazine group (79%; OR 3.34, 95% CI 1.67-8.6; P=0.003), with the number needed to treat in order to prevent 1 subocclusion episode of 3.7 favoring AZA. The occlusion-free time interval was longer in the AZA group compared with the mesalazine group (28.8 vs. 18.3 months; P=0.000). The occlusion-free survival at 12, 24, and 36 months was significantly higher in the AZA group (91%, 81%, and 72%, respectively) than in the mesalazine group (64.7%, 35.3%, and 23.5%, respectively; P<0.05 for all comparisons).
  
  
  CONCLUSIONS
  In an exploratory analysis of patients with subocclusive ileocecal CD, maintenance therapy with AZA is more effective than mesalazine for eliminating or postponing recurrent intestinal obstruction during 3 years of therapy.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Diseases Center, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Juiz de Fora, Brazil.
authors.forename: Fernando Mendonça
authors.initials: FM
authors.lastname: Vidigal
authors.affiliation: Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Diseases Center, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Juiz de Fora, Brazil.
authors.forename: Gláucio Silva
authors.initials: GS
authors.lastname: de Souza
authors.affiliation: Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Diseases Center, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Juiz de Fora, Brazil.
authors.forename: Liliana Andrade
authors.initials: LA
authors.lastname: Chebli
authors.affiliation: Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Diseases Center, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Juiz de Fora, Brazil.
authors.forename: Tarsila Campanha
authors.initials: TC
authors.lastname: da Rocha Ribeiro
authors.affiliation: Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Diseases Center, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Juiz de Fora, Brazil.
authors.forename: Maria Cristina Vasconcellos
authors.initials: MC
authors.lastname: Furtado
authors.affiliation: Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Diseases Center, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Juiz de Fora, Brazil.
authors.forename: Antonio Carlos Santana
authors.initials: AC
authors.lastname: Castro
authors.affiliation: Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Diseases Center, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Juiz de Fora, Brazil.
authors.forename: André Luis Tavares
authors.initials: AL
authors.lastname: Pinto
authors.affiliation: Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Diseases Center, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Juiz de Fora, Brazil.
authors.forename: Bruno
authors.initials: B
authors.lastname: do Valle Pinheiro
authors.affiliation: Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Diseases Center, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Juiz de Fora, Brazil.
authors.forename: Fabio Heleno
authors.initials: FH
authors.lastname: de Lima Pace
authors.affiliation: Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Diseases Center, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Juiz de Fora, Brazil.
authors.forename: Juliano
authors.initials: J
authors.lastname: Machado de Oliveira
authors.affiliation: Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Diseases Center, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Juiz de Fora, Brazil.
authors.forename: Karine Andrade
authors.initials: KA
authors.lastname: de Oliveira Zanini
authors.affiliation: Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Diseases Center, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Juiz de Fora, Brazil.
authors.forename: Pedro Duarte
authors.initials: PD
authors.lastname: Gaburri
authors.affiliation: Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Diseases Center, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Juiz de Fora, Brazil.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Zanini
authors.affiliation: Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Diseases Center, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Juiz de Fora, Brazil.
authors.forename: Luiz Cláudio
authors.initials: LC
authors.lastname: Ribeiro
authors.affiliation: Division of Gastroenterology, Department of Medicine, Inflammatory Bowel Diseases Center, University Hospital of the Federal University of Juiz de Fora, University of Juiz de Fora School of Medicine, Juiz de Fora, Brazil.
authors.forename: Julio Maria Fonseca
authors.initials: JM
authors.lastname: Chebli
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use*; D003424:Crohn Disease / Q000188:drug therapy* / Q000517:prevention & control*; D003710:Demography; D005260:Female; D006801:Humans; D007080:Ileocecal Valve / Q000473:pathology* / Q000528:radiation effects; D007415:Intestinal Obstruction / Q000188:drug therapy* / Q000517:prevention & control*; D053208:Kaplan-Meier Estimate; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use*; D008875:Middle Aged; D012008:Recurrence; D012907:Smoking / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019804:Mesalamine; D001379:Azathioprine