Article Text

Download PDFPDF
Nodular regenerative hyperplasia in patients with inflammatory bowel disease treated with azathioprine
  1. G Vernier-Massouille1,
  2. J Cosnes2,
  3. M Lemann3,
  4. P Marteau4,
  5. W Reinisch5,
  6. D Laharie6,
  7. G Cadiot7,
  8. Y Bouhnik8,
  9. M De Vos9,
  10. A Boureille10,
  11. B Duclos11,
  12. P Seksik2,
  13. J-Y Mary12,
  14. J-F Colombel1
  1. 1Department of Hepato-Gastroenterology, Hôpital Huriez, Lille, France
  2. 2Department of Hepato-Gastroenterology, Hôpital Saint Antoine, Paris, France
  3. 3Department of Hepato-Gastroenterology, Hôpital Saint Louis, Paris, France
  4. 4Department of Hepato-Gastroenterology, Hôpital Lariboisière, Paris, France
  5. 5Department of Hepato-Gastroenterology, University of Vienna, Austria
  6. 6Department of Hepato-Gastroenterology, Hôpital Haut-Leveque, Bordeaux, France
  7. 7Department of Hepato-Gastroenterology, Hôpital Robert Debré, Reims, France
  8. 8Department of Hepato-Gastroenterology, Hôpital Beaujon, Paris, France
  9. 9Department of Hepato-Gastroenterology, University of Gand, Belgium
  10. 10Department of Hepato-Gastroenterology, Hôtel Dieu, Nantes, France
  11. 11Department of Hepato-Gastroenterology, Hôpital Universitaire de Hautepierre, Strasbourg, France
  12. 12Department of Hepato-Gastroenterology, Inserm U717, Université Paris 7, Paris
  1. Correspondence to:
    J F Colombel
    Department of Hepato-Gastroenterology, Hôpital Claude Huriez, CH et U de Lille, France; jfcolombel{at}


Aim: To assess the characteristics and clinical course of nodular regenerative hyperplasia (NRH) in patients with inflammatory bowel disease treated with azathioprine, so as to estimate the frequency of this complication and search for risk factors.

Methods: Cases were identified through a systematic survey of patients followed at 11 centres. At one centre, the cumulative risk of NRH was estimated and a case–control study was undertaken to identify risk factors.

Results: 37 cases of NRH (30 male, 7 female) were identified between 1994 and 2005. The median dose of azathioprine was 2 mg/kg/d (range 1.5 to 3.0). The median time between the start of azathioprine and the diagnosis of NRH was 48 months (range 6 to 187). After a median follow up period of 16 months (range 1 to 138), 14 patients developed complications of portal hypertension. Using multivariate analysis, male sex and stricturing behaviour were the two risk factors associated with NRH in patients treated with azathioprine. The cumulative risk calculated from the database (one centre) was 0.5% at 5 years (95% confidence interval, 0.11 to 0.89) and 1.25% at 10 years (0.29 to 2.21).

Conclusions: NRH is a rare but potentially severe complication of azathioprine in patients with inflammatory bowel disease. Clinicians should be aware of this complication, and should monitor liver function tests and platelet counts closely in their patients.

  • NRH, nodular regenerative hyperplasia
  • TIPS, transjugular intrahepatic portosystemic shunt
  • 6-MP, 6-mercaptopurine
  • 6-TG, 6-thioguanine
  • 6-TGN, 6-thioguanine nucleotides
  • azathioprine
  • inflammatory bowel disease
  • nodular regenerative hyperplasia
  • portal hypertension

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Published online first 15 May 2007

  • Conflict of interest: None declared.

Linked Articles

  • Digest
    Robin Spiller Emad M El-Omar