Introduction Recent meta-analyses of population based IBD mortality studies have shown no increase in standardised mortality ratio for ulcerative colitis (UC)¹, but a small increase for Crohn’s disease (CD)². 26–50% of deaths in CD patients were related to the underlying IBD diagnosis². The aims of this study were to investigate the death cause distribution in a well defined IBD population and to establish the proportion of deaths related to the underlying diagnosis or treatment.

Methods Retrospective case note review to establish cause of death of all patients on the Exeter IBD database who died in the 9yr period until 31.12.2011. Cases were reviewed by 2 clinicians to establish cause of death and ascertain whether it was related to the underlying diagnosis or treatment.

Results 143 deaths, 82 male. 87 had UC, 46 CD and 10 IBD unclassified. Mean age at diagnosis was 58 (11 – 94). Mean duration of disease at time of death was 17 years (0–61). The median age of death was 72.5 and 79 years for CD and UC respectively (P = 0.001, 95% CI –13 - –3 years).

The underlying disease or treatment was implicated in the cause of death in 35/143 (23%) patients and was more common in CD compared to UC patients (37 vs. 18%, P = 0.03). There was no change over time in the proportion of related deaths.

13/143 (9%) had a diagnosis of colorectal cancer at the time of death; in 8 this was the primary cause of death. 8 had Primary Sclerosing Cholangitis, all of whom died of related complications. 8 patients had a haematological malignancy including 3 patients with colonic lymphomas, 1 with chronic myeloid leukaemia, 2 with non-Hodgkin’s lymphoma and 1 with peripheral T cell lymphoma. Half of these patients had previously been prescribed thiopurines.

10 died during emergency admission for acute IBD. 3 had coexisting enteric infection. 2 died from perforations (gastric and ileal). 7 died of post-operative complications of IBD surgery (3 emergency cases, 4 elective).

94/143 (66%) died of conditions unrelated to IBD (including 23 cardiac, 21 respiratory causes). 38 (27%) died of cancer. A cause of death could not be established for 14 patients.

Conclusion CD patients died at a younger age compared with UC patients and were more likely to die from a complication of IBD or treatment. The proportion of IBD related deaths has not changed within the time period of this study.

Disclosure of Interest None Declared

References

1. Jess, T et al. Am J Gastro 102, 609–617 (2007).

2. Duricova, D. et al. IBD 16, 347–353 (2010).