{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T18:27:44Z","timestamp":1793212064599,"version":"4.5.0"},"reference-count":196,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2023,9,6]],"date-time":"2023-09-06T00:00:00Z","timestamp":1693958400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,9,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Perianal fistulizing Crohn\u2019s disease (CD) represents a severe phenotype of CD that is associated with significant morbidity and reduction in quality of life. Perianal fistulizing CD is caused by a complex interplay of genetic predisposition, immune dysregulation, gut dysbiosis, and various unknown physiological and mechanical factors. A multidisciplinary approach is hence required for optimal management . A detailed anatomical description and classification of perianal fistula, including comprehensive clinical, endoscopic, and radiological diagnostic workup, is an important prerequisite to treatment. For simple perianal fistulas, use of antibiotics and immunomodulators, with or without fistulotomy, are appropriate measures. The medical management of complex perianal fistula, on the other hand, requires adequate control of infection before initiation of therapy with immunomodulators. In active complex perianal fistula, anti-tumor necrosis factors remain the most accepted therapy, with concomitant use of antibiotics or immunomodulators enhancing the efficacy. For patients refractory to anti-tumor necrosis factors, treatment with anti-integrins, anti-interleukins, and small molecules is being evaluated. Mesenchymal stem cells, hyperbaric oxygen therapy, and exclusive enteral nutrition have also been investigated as adjunct therapies. Despite the expansion of the medical armamentarium, a large proportion of the patients require surgical interventions. In this review, we provide an up-to-date overview of the pathophysiology, clinical presentation, diagnosis, and medical management of perianal fistulizing CD. A brief overview of the surgical management of perianal fistulizing CD is also provided.<\/jats:p>","DOI":"10.1093\/ibd\/izad195","type":"journal-article","created":{"date-parts":[[2023,8,11]],"date-time":"2023-08-11T16:11:58Z","timestamp":1691770318000},"page":"1579-1603","source":"Crossref","is-referenced-by-count":43,"title":["Management of Perianal Fistulizing Crohn\u2019s Disease"],"prefix":"10.1093","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7163-0454","authenticated-orcid":false,"given":"Arshdeep","family":"Singh","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Dayanand Medical College , Ludhiana , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vandana","family":"Midha","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Dayanand Medical College , Ludhiana , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gursimran Singh","family":"Kochhar","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology and Nutrition, Allegheny Health Network , Pittsburgh, PA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Shen","sequence":"additional","affiliation":[{"name":"Center for Interventional Inflammatory Bowel Disease, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center , New York, NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6961-6389","authenticated-orcid":false,"given":"Ajit","family":"Sood","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Dayanand Medical College , Ludhiana , India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,9,6]]},"reference":[{"issue":"10","key":"2024090305520337600_CIT0001","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1093\/ibd\/izab287","article-title":"Epidemiology and natural history of perianal Crohn\u2019s disease: a systematic review and meta-analysis of population-based cohorts","volume":"28","author":"Tsai","year":"2021","journal-title":"Inflamm Bowel Dis."},{"issue":"6","key":"2024090305520337600_CIT0002","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1093\/ibd\/izy329","article-title":"Update on the natural course of fistulizing perianal Crohn\u2019s disease in a population-based cohort","volume":"25","author":"Park","year":"2019","journal-title":"Inflamm Bowel Dis."},{"issue":"7","key":"2024090305520337600_CIT0003","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1093\/ibd\/izy374","article-title":"A 10-year follow-up study 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