Aliment Pharmacol Ther 2011; 33: 707–713


Background  Although thiopurines are considered safe in humans, they are still pregnancy FDA category D drugs. Prevention of post-operative recurrence is a challenge in clinical practice in Crohn’s disease. The European Crohn’s and Colitis Organisation consensus states that thiopurines should be considered in high-risk patients.

Aim  To perform a worldwide survey for evaluating the extent to which gastroenterologists who are experts in the field of IBD are utilising thiopurines during pregnancy and in the post-operative setting in Crohn’s disease.

Methods  This was a Web-based cross-sectional, statement-based survey, which was conducted among experts who have published at least once in the field of thiopurines in IBD.

Results  Between 20 December 2009 and 9 April 2010, 175 questionnaires were received. The median number of IBD patients per physician per year was 400 (IQR 25–75th, 188–600) and the total number of IBD patients followed by all responders was 82 379. In a pregnant woman with a history of severe Crohn’s disease in clinical remission after 1 year on azathioprine, 89% of experts usually continue azathioprine until delivery and 9% of physicians never administrate azathioprine during pregnancy. After ileocecal resection for Crohn’s disease, 39% of physicians initiate azathioprine only in high-risk patients, 28% of practitioners prescribe azathioprine according to endoscopic evaluation, 20% of gastroenterologists systematically initiate azathioprine and 13% have a different attitude.

Conclusions  Almost 9 of 10 physicians continue azathioprine throughout pregnancy. About 7 of 10 physicians prescribe azathioprine in the post-operative setting according to the European Crohn’s and Colitis Organisation recommendations, whereas one-fifth of practitioners systematically initiate azathioprine after surgery.