Search in the Abstract Database

Search Abstracts 2011

* = Presenting author

P258. Anti-TNF as risk factor for free perforations in Crohn's disease? A case control study

E.J. Eshuis, G. Griffioen, P.C.F. Stokkers, D.T. Ubbink, W.A. Bemelman

Academic Medical Center, Amsterdam, The Netherlands

Aim: Although the occurrence of free perforation in Crohn's disease (CD) is rare, clinical observation led to the question whether anti-TNF treatment is a risk factor for free perforation. Hypothetically, anti-TNF treatment hinders the development of an inflammatory mass, which normally encapsulates the imminent perforation. Aim of this study was to investigate the possible relation between anti-TNF treatment and the occurrence of free perforations defined as intestinal perforations leading to emergency surgery.

Materials and Methods: The design of this study was a case control study. All emergency operation reports in the period 1999–2009 in patients diagnosed with CD were checked for the presence of free perforation. These cases were compared to a six fold control group derived from our CD patients' database. Cases and controls were matched for age, gender, Montreal classification and surgical stage to ensure equal disease severity in cases and controls. Cases and controls were then compared regarding previous or current exposure to anti-TNF treatment.

Results: Thirteen patients underwent emergency surgery for free perforation. Eight (61.5%) had been treated with anti-TNF within 5 months before the perforation. In the 78 matched controls, 29 (37.2%) had been or were still treated with anti-TNF. The odds for a free perforation adjusted for known confounders were significantly higher in anti-TNF treated CD patients, albeit with a large confidence interval (OR 23.0, 95% CI 2.2–238.5).

Conclusion: This study showed a higher occurrence of free perforations in CD patients with anti-TNF therapy compared to those without anti-TNF therapy. Patients with CD and anti-TNF treatment presenting with acute abdominal pain must be suspected of this complication.