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We read with great interest the meta-analysis by Kandiel et al (Gut 2005;54:1121–5), the purpose of which was to provide a more precise estimate of the relative risk of lymphoma among inflammatory bowel disease (IBD) patients treated with azathioprine or 6-mercaptopurine (6-MP). Based on the six studies included in their meta-analysis, Kandiel et al determined that the risk of lymphoma among IBD patients who did not receive immunomodulators was similar to that of the general population while the lymphoma risk among IBD patients treated with azathioprine/6-MP was increased approximately fourfold. It is reassuring that the largest study included in their meta-analysis, which utilised the UK General Practice Research Database, failed to show a significantly higher risk of lymphoma among 16 996 IBD patients, regardless of whether or not patients received azathioprine/6-MP.1 While several population based and hospital based studies have similarly failed to identify a significantly increased …
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