Inflammatory bowel disease cause-specific mortality: a primer for clinicians

Area of Science:

• Gastroenterology
• Internal Medicine
• Epidemiology

Background:

• Inflammatory bowel disease (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), is associated with significant morbidity.
• Historically, IBD mortality was considered low, primarily linked to colorectal cancer.
• Recent evidence indicates higher mortality rates and emerging threats in IBD patients.

Purpose of the Study:

• To review and update clinicians on the causes of mortality in inflammatory bowel disease (IBD).
• To inform patients about mortality risks to facilitate shared decision-making in IBD treatment.
• To identify evolving mortality patterns in Crohn's disease and ulcerative colitis.

Main Methods:

• A comprehensive literature search of the MEDLINE database was performed.
• Keywords included "inflammatory bowel disease," "Crohn's disease," "ulcerative colitis," and "mortality."

Main Results:

• Mortality causes differ slightly between CD and UC; colorectal cancer's role remains debated.
• Gastrointestinal disease, infection, and respiratory conditions drive CD mortality.
• UC mortality is mainly due to gastrointestinal disease and infection.
• Clostridium difficile infection is an emerging cause of mortality in IBD.
• Increased risk of thromboembolic disease observed in both CD and UC patients.

Conclusions:

• Conventional mortality causes like malignancy may be less significant than previously perceived in IBD.
• Emerging threats, particularly infections such as C. difficile, are critical considerations.
• While CD and UC share mortality causes, specific differences in cause-specific mortality exist.