Background: Perianal fistulas affect up to one third of Crohn's patients during the course of their disease. Despite the considerable disease burden, current treatment options remain unsatisfactory. The fifth scientific workshop (SWS5) of the European Crohn's and Colitis Organization (ECCO) focused on the pathophysiology and clinical impact of fistulas in the disease course of patients with Crohn's disease (CD).
Methods: Whereas one working group of SWS5 focused on pathophysiology, the ECCO SWS5 Working Group on clinical aspects of perianal fistulising Crohn's disease (pCD) consisted of 13 participants, gastroenterologists, colorectal surgeons and a histopathologist, with expertise in the field of inflammatory bowel diseases. A systematic review of literature was performed.
Results: Four main areas of interest were identified: natural history of pCD, morphological description of fistula tracts, outcome measures (including clinical and patient-reported outcome measures, as well as MR imaging) and randomized controlled trials on pCD.
Conclusions: The treatment of perianal fistulising Crohn's disease remains a multidisciplinary challenge. To optimise management a reliable classification and proper trial endpoints are needed. This could lead to standardized diagnosis, treatment and follow-up of Crohn's perianal fistulas and the execution of well-designed trials that provide clear answers. The prevalence and the natural history of pCD needs further evaluation.