Risk of post-operative infections with anti-TNF therapy

Anti-TNF therapy is the current standard of care for moderate to severe Crohn's disease and ulcerative colitis. However, despite advancements in immunosuppressive therapy, many patients will require surgery during their disease course. Patients are often exposed to immunosuppressive therapy peri-operatively, leading to concern about possible increased risks of infectious complications. While studies have established the infectious risk associated with steroids and the general safety of thiopurines, the effect of pre-operative anti-TNF on post-operative complications in inflammatory bowel disease is controversial. This chapter reviews current knowledge regarding anti-TNF and the risk of post-operative infections and proposes potential management strategies.