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David A. Schwartz, Leyla J. Ghazi, Miguel Regueiro, Guidelines for Medical Treatment of Crohn's Perianal Fistulas: Critical Evaluation of Therapeutic Trials, Inflammatory Bowel Diseases, Volume 21, Issue 4, 1 April 2015, Pages 737–752, https://doi.org/10.1097/MIB.0000000000000377
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Crohn's perianal fistulas are a common and debilitating complication of Crohn's disease (CD). Patient's who develop perianal fistulas often suffer from persistent drainage, pain, and incontinence. Understandably, this frequently leads to a poor quality of life.1,2 The damage caused by Crohn's perianal fistulas can be worsened by improper treatment such as over aggressive surgical intervention or failure to recognize the manifestations of the disease process itself.
Perianal fistulizing disease is a common manifestation of CD with approximately 21% to 23% of patients developing at least 1 perianal fistula during their lifetime.3,–5 The risk of developing a perianal fistula is higher if there is active disease in the rectum.4,5 The treatment paradigm for treating Crohn's perianal fistulas has changed rapidly since the development of anti-tumor necrosis alpha antibodies.6,7 The role of imaging and multispecialty care involving the gastroenterologist and the surgeon for these patients also continues to evolve.
The accompanying articles “Guidelines for Imaging of Crohn's Perianal Fistulizing Disease,” “Guidelines for the Surgical Treatment of Crohn's Perianal Fistulas,” and “Guidelines for the Multidisciplinary Management of Crohn's Perianal Fistulas: Summary Statement” propose clinical treatment guidelines for Crohn's perianal fistulas based on the existing clinical data. The quality and efficacy of the data supporting or rejecting the use of a specific imaging modality, surgical intervention, or medical therapy are detailed in this technical review.
