Anthony S. Mee

Re-introduction of azathioprine in previously intolerant patients.

Background and aims Azathioprine is an important steroid sparing agent in the management of patients with inflammatory bowel disease. However, side effects are a problem in a significant minority of patients. We proposed that desensitization might increase the number of patients able to tolerate the drug. Methods Successive inflammatory bowel disease patients who were intolerant to azathioprine in our hospital gastroenterology clinic were invited to recommence the drug at a low dose, gradually building up to a therapeutic dose. Patients were observed for the recurrence of side effects. Patients who did not wish to participate were offered alternative immunosuppressant therapy. Results Fourteen patients elected to attempt desensitization. Nine of these (64%) were able to tolerate a full dose of azathioprine. The remainder suffered a return of their side effects and were offered alternative treatment. Conclusions Azathioprine can be tolerated in some people who have been previously intolerant by the use of desensitization.

GORD: current drug treatment and maintenance options

Gastro‐oesophageal reflux disease is a com mon complaint and lifestyle changes and drug treatment are usually successful in con trolling symptoms. Our Drug review describes the mode of action and efficacy of the drugs used in treatment and maintenance, followed by an analysis of prescription data, sources of further information and the Datafile. Copyright