TNF and Cowden disease: At the time of study inclusion, 35% of patients had prior CD-related surgery (n = 26), 24% had prior or active peri-anal disease (n = 18) and 62 patients had previously failed anti-TNF alpha therapy, and 5% of the patients were on concurrent immunosuppressive therapy (n = 4) and 9% were on concomitant steroid therapy (n = 7).