The influence of oral contraceptive (OCP) use as a risk factor for the development of Crohn's disease is disputed. We wished to determine if OCP use affected the risk of recurrence (defined as need for a second surgery) in women who had already undergone a resection for Crohn's disease. We hypothesized that if contraceptive use was a risk factor for disease development, it could influence recurrence. Using a mail questionnaire, we surveyed 138 women regarding their OCP use following surgery for Crohn's disease. All participants were between ages 16 and 35 at the time of their initial surgery which occurred between 1966 and 1984. Ninety-seven women (70%) responded. Mean follow-up was 9.9 years (range 4-27). Forty-six women required a second surgery. The recurrence rate as determined by actuarial analysis, was 27.2% (95% confidence intervals (CI95 16.5-38.1) and 58.0% (CI95 37.8-78.2) at 5 and 10 years, respectively. Thirty-two women took OCP in the first year following surgery. Eleven OCP users (34.4%) required additional surgery compared to 34 (53.1%) of nonusers. Using life table analysis, the percentage requiring a second surgery was 25.0% (CI95 6.9-43.1) and 40.7% (CI95 1.5-80%) at 5 and 10 years, respectively, for users compared to 28.4% (CI95 6.9-43.1) and 64.0% (CI95 40.5-87.5) for nonusers (Lee Desu, P greater than 0.05). When surveyed about their reasons for using OCP, most women stated that their disease did not affect their decision to use contraceptives.(ABSTRACT TRUNCATED AT 250 WORDS)
PIP: Crohn's disease (CD) is a chronic inflammatory condition affecting any area of the gastrointestinal tract from mouth to anus. This retrospective study determined the effects of oral contraceptive (OC) use on the likelihood of surgical recurrence in a cohort of patients who underwent surgery for CD. Questionnaires were mailed to 138 women who had undergone surgery for CD. Participants were 16-35 years of age. Only 97 women responded and 84 completed the second questionnaire. There were no significant differences between responders and nonresponders in terms of age at surgery, indication for surgery, and length of time in hospital. The 5-year recurrence rate was 27.2%, rising to 58.0% by 10 years. Only 32 women used OCs in the first year following surgery. With the life table analysis, the percentage requiring second surgery was 25.0% and 40.7% for users, while it was 28.4% and 64.0% for nonusers at 5 and 10 years, respectively. The majority of women reported that their disease did not constitute a major influence in their decision to use OCs. Among these women users, 10.7% were concerned about the CD risk to offspring. There were no significant differences between women with and without recurrence in terms of their reasons for using or not using OCs. Based on the results of the study, it was concluded that there was less evidence to support the hypothesis that OC use increased the risk of women requiring a second operation.