Incidence of and Risk Factors for Free Bowel Perforation in Patients with Crohn’s Disease

Abstract

Background

Incidence of and risk factors for intestinal free perforation (FP) in patients with Crohn's disease (CD) are not established.

Aim

To establish rate of and risk factors for FP in a large cohort of CD patients.

Methods

Medical records of CD patients who visited Asan Medical Center from June 1989 to December 2012 were reviewed. After matching the FP patients to controls (1:4) by gender, year, and age at CD diagnosis, and disease location, their clinical characteristics were compared using conditional logistic regression analysis.

Results

Among 2043 patients who were included in our study cohort, 44 patients (2.15%) developed FP over a median follow-up period of 79.8 months (interquartile range 37.3–124.6), with an incidence of 3.18 per 1000 person-years [95% confidence interval (CI) 2.37–4.28]. All 44 patients underwent emergency surgery, and eight patients underwent reoperation within 12 months (8/44, 18.2%). Multivariable-adjusted analysis revealed that anti-TNF therapy [odds ratio (OR), 3.73; 95% CI 1.19–11.69; p = 0.024] was associated with an increased risk of FP.

Conclusions

The incidence of FP in a large cohort of Korean CD patients was 2.15%, which was similar to that in Western reports. Anti-TNF therapy could be risk factors for FP.

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