{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:03:59Z","timestamp":1790143439022,"version":"4.0.1"},"reference-count":25,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100007723","name":"Takeda Pharmaceuticals U.S.A.","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007723","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005205","name":"Janssen Research and Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005205","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Over recent decades, there has been a more pronounced shift towards earlier therapeutic intervention in luminal Crohn's disease (CD). However, it remains unclear if similar strategies apply to active perianal fistulizing CD (pCD). This study explores the patient journey by assessing pCD management across diagnostic time periods in a large national cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with active pCD were included in a multicentre cohort across 41 Dutch academic and non\u2010academic hospitals. Diagnostic modalities, medical and surgical treatments were evaluated over the pCD disease course, particularly within the first year after pCD diagnosis, and compared across four time periods: &lt;\u20092010, 2010\u20132015, 2015\u20132020 and &gt;\u20092020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four hundred and forty patients were included (53.0% female; median pCD disease course 4.1\u2009years). 12% were diagnosed before 2010, 11% in 2010\u20132015, 31% in 2015\u20132020, 46% after 2020. Over time, imaging (MRI or EUS) within the first year after pCD diagnosis was used in 37% of cases diagnosed before 2010 to 66%, 83% and 95% in subsequent periods. Endoscopic evaluation for proctitis was performed in 23%, 40%, 57% and 60%. First\u2010line anti\u2010TNF use was initiated in 27% followed by 58%, 68% and 69%. A seton was placed in 27% initially and in 42%, 51% and 52% in later years. Fistula surgery aimed at closure was performed in 14%, 4%, 8% and 19% over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This national cohort illustrates substantial progress in early pCD management over time. These shifts likely reflect growing clinical awareness of the importance of early and multidisciplinary interventions. However, surgical procedures aimed at fistula closure remain infrequently performed in the early disease course, which may be related to the inclusion of a predominantly therapy\u2010refractory patient group.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/codi.70613","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:28:26Z","timestamp":1788413306000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evolving patient journey in the management of active perianal fistulizing Crohn's disease: A temporal perspective"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8515-425X","authenticated-orcid":false,"given":"Michiel T. J.","family":"Bak","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology Erasmus University Medical Center Rotterdam  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0027-0672","authenticated-orcid":false,"given":"Merel M.","family":"Verweij","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Erasmus University Medical Center Rotterdam  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3383-9035","authenticated-orcid":false,"given":"Laurents P. S.","family":"Stassen","sequence":"additional","affiliation":[{"name":"Department of Surgery Maastricht University Medical Center+  Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9425-8683","authenticated-orcid":false,"given":"Christianne J.","family":"Buskens","sequence":"additional","affiliation":[{"name":"Department of Surgery Amsterdam University Medical Center  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1245-0928","authenticated-orcid":false,"given":"Aagje M.","family":"Pronk","sequence":"additional","affiliation":[{"name":"Department of Surgery Amsterdam University Medical Center  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0687-6778","authenticated-orcid":false,"given":"Jarmila D. W.","family":"van der Bilt","sequence":"additional","affiliation":[{"name":"Department of Surgery Amsterdam University Medical Center  Amsterdam The Netherlands"},{"name":"Department of Surgery Flevoziekenhuis  Almere The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7485-1844","authenticated-orcid":false,"given":"Liesbeth J.","family":"Munster","sequence":"additional","affiliation":[{"name":"Department of Surgery Flevoziekenhuis  Almere The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8357-9887","authenticated-orcid":false,"given":"Nanne K. H.","family":"de Boer","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers Vrije Universiteit Amsterdam, AGEM Research Institute  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krisztina B.","family":"Gecse","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers Vrije Universiteit Amsterdam  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0885-1750","authenticated-orcid":false,"given":"Robert\u2010Jan B.","family":"Pierik","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Erasmus University Medical Center Rotterdam  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline D. M.","family":"Witjes","sequence":"additional","affiliation":[{"name":"Department of Surgery IJsselland Hospital  Capelle aan den IJssel The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire E.","family":"Fitzpatrick","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology IJsselland Hospital  Capelle aan den IJssel The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5445-4011","authenticated-orcid":false,"given":"Stephanie O.","family":"Breukink","sequence":"additional","affiliation":[{"name":"Department of Surgery Maastricht University Medical Center+  Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6981-6516","authenticated-orcid":false,"given":"Marieke J.","family":"Pierik","sequence":"additional","affiliation":[{"name":"School for Nutrition and Translational Research in Metabolism (NUTRIM) Maastricht University  Maastricht The Netherlands"},{"name":"Department of Gastroenterology and Hepatology Maastricht University Medical Center+  Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loes H. C.","family":"Nissen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Jeroen Bosch Hospital  Den Bosch The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emiel G. G.","family":"Verdaasdonk","sequence":"additional","affiliation":[{"name":"Department of Surgery Jeroen Bosch Hospital  Den Bosch The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lennard P. L.","family":"Gilissen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Catharina Hospital  Eindhoven The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanne G.","family":"Bloemen","sequence":"additional","affiliation":[{"name":"Department of Surgery Catharina Hospital  Eindhoven The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wout G. N.","family":"Mares","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Gelderse Vallei Hospital  Ede The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabie M.","family":"de Jong","sequence":"additional","affiliation":[{"name":"Department of Surgery Gelderse Vallei Hospital  Ede The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1108-8522","authenticated-orcid":false,"given":"Marjolein","family":"Sikkema","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Elisabeth\u2010TweeSteden Ziekenhuis  Tilburg Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David D. E.","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"Department of Surgery Elisabeth\u2010TweeSteden Ziekenhuis  Tilburg Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2226-0270","authenticated-orcid":false,"given":"Dominique","family":"Bierens\u2010Peters","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Elisabeth\u2010TweeSteden Ziekenhuis  Tilburg Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"de Jonge","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Albert Schweitzer Ziekenhuis  Dordrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7804-1660","authenticated-orcid":false,"given":"Robert M.","family":"Smeenk","sequence":"additional","affiliation":[{"name":"Department of Surgery Albert Schweitzer Ziekenhuis  Dordrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bindia J.","family":"Jharap","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Meander Medical Center  Amersfoort The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelien","family":"de Witte","sequence":"additional","affiliation":[{"name":"Department of Surgery Zuyderland Medical Center  Sittard\u2010Geleen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mari\u00eblle","family":"Romberg\u2010Camps","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Zuyderland Medical Center  Sittard\u2010Geleen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander G. L.","family":"Bodelier","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Amphia Hospital  Breda The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8409-251X","authenticated-orcid":false,"given":"Ninos","family":"Ayez","sequence":"additional","affiliation":[{"name":"Department of Surgery Amphia Hospital  Breda The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6154-223X","authenticated-orcid":false,"given":"Xander G.","family":"Vos","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Dijklander Hospital  Hoorn The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margot A.","family":"van Herwaarden","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Deventer Hospital  Deventer The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzan","family":"Bos\u2010Poliste","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Deventer Hospital  Deventer The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fleur A.","family":"Indemans","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Maasziekenhuis Pantein  Boxmeer The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra G. A.","family":"van Boeckel","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology St. Antonius Hospital  Nieuwegein The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michiel D.","family":"Voskuil","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Isala Hospital  Zwolle The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Egbert\u2010Jan","family":"van der Wouden","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Isala Hospital  Zwolle The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette D.","family":"van Dalsen","sequence":"additional","affiliation":[{"name":"Department of Surgery Isala Hospital  Zwolle The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saskia","family":"Willemsen\u2010Maas","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology ZorgSaam Hospital  Terneuzen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigrid","family":"Vandebosch","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology ZorgSaam Hospital  Terneuzen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7025-2783","authenticated-orcid":false,"given":"Els","family":"van Dessel","sequence":"additional","affiliation":[{"name":"Department of Surgery ZorgSaam Hospital  Terneuzen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob P. R.","family":"Adang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology VieCuri Medical Centre  Venlo The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joop L. M.","family":"Konsten","sequence":"additional","affiliation":[{"name":"Department of Surgery VieCuri Medical Centre  Venlo The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanne M.","family":"van Aalten","sequence":"additional","affiliation":[{"name":"Department of Surgery Groene Hart Hospital  Gouda The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2669-0586","authenticated-orcid":false,"given":"Margriet H.","family":"Wobbes","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Groene Hart Hospital  Gouda The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4674-5739","authenticated-orcid":false,"given":"Esmerij P.","family":"van der Zanden","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Amstelland Hospital  Amstelveen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanne C.","family":"Veltkamp","sequence":"additional","affiliation":[{"name":"Department of Surgery Amstelland Hospital  Amstelveen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bareld B.","family":"Pultrum","sequence":"additional","affiliation":[{"name":"Department of Surgery Martini Hospital  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rinze W. F.","family":"ter Steege","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Martini Hospital  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merel M.","family":"Tielemans","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Bravis Hospital  Roosendaal The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mike","family":"van der Have","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Admiral de Ruijter Hospital  Goes The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8467-8924","authenticated-orcid":false,"given":"Abraham T.","family":"Zuur","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Frisius MC  Heerenveen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter C. J.","family":"ter Borg","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Ikazia Hospital  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2488-1518","authenticated-orcid":false,"given":"Henri","family":"Braat","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Medisch Spectrum Twente  Enschede The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tjeerd S.","family":"Aukema","sequence":"additional","affiliation":[{"name":"Department of Surgery Hagaziekenhuis  the Hague The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rogier J. L.","family":"Stuyt","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Hagaziekenhuis  the Hague The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles C.","family":"van Rossem","sequence":"additional","affiliation":[{"name":"Department of Surgery Maasstad Hospital  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. 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