Incidence of and Risk Factors for Free Bowel Perforation in Patients with Crohn's Disease.
Incidence of and risk factors for intestinal free perforation (FP) in patients with Crohn's disease (CD) are not established.



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



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.



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.



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.
Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
Jong Wook
JW
Kim
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.|Department of Health Screening and Promotion Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Ho-Su
HS
Lee
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. bdye@amc.seoul.kr.|Inflammatory Bowel Disease Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. bdye@amc.seoul.kr.
Byong Duk
0000-0001-6647-6325
BD
Ye
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.|Inflammatory Bowel Disease Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Suk-Kyun
SK
Yang
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Sung Wook
SW
Hwang
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.|Inflammatory Bowel Disease Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Sang Hyoung
SH
Park
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Dong-Hoon
DH
Yang
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.|Inflammatory Bowel Disease Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Kyung-Jo
KJ
Kim
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Jeong-Sik
JS
Byeon
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Seung-Jae
SJ
Myung
Inflammatory Bowel Disease Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.|Department of Colon and Rectal Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Yong Sik
YS
Yoon
Inflammatory Bowel Disease Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.|Department of Colon and Rectal Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Chang Sik
CS
Yu
Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Jin-Ho
JH
Kim
D000328:Adult; D016022:Case-Control Studies; D003108:Colonic Diseases / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D007077:Ileal Diseases / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D015994:Incidence; D000069285:Infliximab / Q000627:therapeutic use; D007416:Intestinal Perforation / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D007579:Jejunal Diseases / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D008297:Male; D012086:Reoperation; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab
Anti-TNF; Crohn’s disease; Intestinal perforation; Stricture