The authors discussed their own experience with management of 19 patients with agresive perforating type of Crohn’s disease in a relaps state. In this group treatment by antiTNF and cyklosporine and azathioprine was combined. For perianal fistulas, 11 patients received antiTNF three times, remaining 8 patients received only one dosis. In a group of 19 treated patients the clinical succesful answer was registered in 17 patients and evaluated by CDAI and PDAI index (89.5% or 22% according to error of small samples). In 9 cases the fistulas were closed. The most important contribution of this drug combination is a morphologic improving in 14 patients what was confirmed by objective methods. 3 patients were sent to the limited elective surgery. In the remaining part of the group a clinical remission or asymptomatic reccurence lasted after 15 months follow-up in 11 of 14 patients which (78,6% or 23.6% of errors of small samples). Assessment Wilcoxon test showed the successful treatment on the level of l% or 5% significance. These results outweight the average success in monotherapy by only antiTNF. The authors appreciate the combination of anti-TNF and azathioprine and cyclosporine treatment as a safe and perspective method for aggressive perforating type of Crohn’s disease management.

        Key words: IBD - inflammatory bowel disease – CD - Crohn’s disease – CyA - cyclosporine A – AZA - azathioprine – 6-MP - 6-merkaptopourin – MTX - metotrexate – antiTNF - anti-tumor necrosing factor