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From Medwire:

http://www.medwire.md/News_single.aspx?newstype=20&date=20040813&story_id=27345

Mortality increased among CD patients

Gut 2004; 53: 1309-1313

Italian research findings suggest that patients with Crohn's disease (CD) are four times more likely to die of lung cancer than the general population, whereas those with ulcerative colitis (UC) have a 70% reduced risk of dying from the disease.

Having previously identified divergent patterns of mortality for smoking related diseases in patients with CD and UC in a short-term study, G Masala (CSOP-Scientific Institute of Tuscany) and colleagues now report a long-term follow-up of the same patients, re-evaluating the mortality rates after a median of 15 years.

For the study, the team recruited 920 patients diagnosed with CD (n=231) and UC (n=689) between 1978 and 1992, and followed the patients until the end of 2001.

Using age-group and sex-specific local and national mortality rates, the investigators calculated the number of deaths normally expected in the general population, and compared these figures with the death rates observed among the patients.

Overall mortality was 50% higher than expected among the patients with CD, Masala et al report in the journal Gut. In contrast, mortality was reduced by 30% in the individuals with UC.

Specifically, deaths from gastrointestinal disease were significantly increased among the CD patients, with a standardized mortality ratio (SMR) of 4.49 compared with the expected mortality rates. Total cancer mortality was also significantly increased in this patient group (SMR=2.10), particularly for deaths from lung cancer (SMR=4).

Patients with UC, however, had a significantly reduced number of deaths caused by cardiovascular problems (SMR=0.67) and lung cancer (SMR=0.32).

Noting that 58% of the CD patients who had died were current smokers, compared with 26% of the deceased UC patients, the authors suggest that smoking may have contributed significantly to the increased mortality seen among the patients with CD.

"Family doctors should consider stopping cigarette smoking a priority for CD patients," they therefore conclude.