{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T03:54:40Z","timestamp":1790394880313,"version":"4.1.0"},"reference-count":77,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Perianal involvement is a well-recognized manifestation of Crohn\u2019s disease (CD). However, non-fistulizing perianal phenotypes remain underrecognized despite their significance in clinical practice and impact on patients\u2019 quality of life. Methods: A narrative review of the literature up to September 2025 was conducted, with an emphasis on studies that differentiated between non-fistulizing and fistulizing lesions. Results: During the CD course, approximately 45% of patients with CD develop non-fistulizing perianal manifestations, including fissures, ulcers, strictures, and skin tags. These lesions may resolve spontaneously with the ongoing CD therapy or additional conservative measures, but some evolve into more complex conditions, with challenging management. Deep ulcers and strictures appear to be associated with a less favorable disease course. While biologic therapy has altered the overall course of CD, its role in treating non-fistulizing perianal Crohn\u2019s disease (PCD) requires further understanding. Surgical intervention, which carries an increased risk of complications, is typically reserved for individuals who are refractory to other treatments. The potential association between non-fistulizing PCD and anal cancer remains uncertain. Conclusions: Non-fistulizing PCD is a clinically significant condition that requires early recognition and individualized management. Prospective studies with standardized lesion classification, careful monitoring of disease course, and evaluation of biologic therapies and biomarkers are needed to develop evidence-based strategies and improve patient outcomes on non-fistulizing PCD.<\/jats:p>","DOI":"10.3390\/jcm14248811","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T14:04:40Z","timestamp":1765548280000},"page":"8811","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Non-Fistulizing Perianal Disease in Crohn\u2019s Disease: Clinical Significance, Pathogenesis, and Management Strategies"],"prefix":"10.3390","volume":"14","author":[{"given":"In\u00eas","family":"Abreu Marques","sequence":"first","affiliation":[{"name":"Gastroenterology Department, Unidade Local de Sa\u00fade do Alto Ave, 4835-044 Guimar\u00e3es, Portugal"},{"name":"Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4704-057 Braga, Portugal"},{"name":"ICVS\/3B\u2019s\u2014PT Government Associate Laboratory, 4710-057 Braga, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiago","family":"C\u00fardia Gon\u00e7alves","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Unidade Local de Sa\u00fade do Alto Ave, 4835-044 Guimar\u00e3es, Portugal"},{"name":"Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4704-057 Braga, Portugal"},{"name":"ICVS\/3B\u2019s\u2014PT Government Associate Laboratory, 4710-057 Braga, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5480-3074","authenticated-orcid":false,"given":"Cl\u00e1udia","family":"Macedo","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Unidade Local de Sa\u00fade do Alto Ave, 4835-044 Guimar\u00e3es, Portugal"},{"name":"Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4704-057 Braga, Portugal"},{"name":"ICVS\/3B\u2019s\u2014PT Government Associate Laboratory, 4710-057 Braga, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Campelo","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Unidade Local de Sa\u00fade do Alto Ave, 4835-044 Guimar\u00e3es, Portugal"},{"name":"Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4704-057 Braga, Portugal"},{"name":"ICVS\/3B\u2019s\u2014PT Government Associate Laboratory, 4710-057 Braga, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Cotter","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Unidade Local de Sa\u00fade do Alto Ave, 4835-044 Guimar\u00e3es, Portugal"},{"name":"Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4704-057 Braga, Portugal"},{"name":"ICVS\/3B\u2019s\u2014PT Government Associate Laboratory, 4710-057 Braga, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"jjaf002","DOI":"10.1093\/ecco-jcc\/jjaf002","article-title":"Diagnosing Crohn\u2019s disease in presumed cryptoglandular perianal fistulas: An expert Delphi consensus on early identification of patients at risk of Crohn\u2019s disease in perianal fistulas (PREFAB)","volume":"19","author":"Munster","year":"2025","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1007\/BF01648416","article-title":"Current status and influence of operation on perianal Crohn\u2019s disease","volume":"1","author":"Keighley","year":"1986","journal-title":"Int. J. Color. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1007\/BF02560279","article-title":"Anorectal Crohn\u2019s Disease A Long-term Perspective","volume":"28","author":"Wolff","year":"1985","journal-title":"Dis. Colon Rectum"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/S0016-5085(75)80270-8","article-title":"Clinical Patterns in Crohn\u2019s Disease: A Statistical Study of 615 Cases","volume":"68","author":"Farmer","year":"1975","journal-title":"Gastroenterology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1556","DOI":"10.1093\/ecco-jcc\/jjae089","article-title":"ECCO Guidelines on Therapeutics in Crohn\u2019s Disease: Surgical Treatment","volume":"18","author":"Adamina","year":"2024","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.1016\/j.gastro.2003.08.025","article-title":"AGA Technical Review on Perianal Crohn\u2019s Disease","volume":"125","author":"William","year":"2003","journal-title":"Gastroenterology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1007\/DCR.0b013e3182099d9e","article-title":"Quality of life in perianal Crohn\u2019s disease: What do patients consider important?","volume":"54","author":"Mahadev","year":"2011","journal-title":"Dis. Colon Rectum"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1186\/s12955-020-01622-7","article-title":"Burden of disease and adaptation to life in patients with Crohn\u2019s perianal fistula: A qualitative exploration","volume":"18","author":"Adegbola","year":"2020","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1002\/ibd.20767","article-title":"Course and treatment of perianal disease in children newly diagnosed with Crohn\u2019s disease","volume":"15","author":"Keljo","year":"2009","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1097\/00054725-199908000-00011","article-title":"An Approach to Perirectal Disease in Inflammatory Bowel Disease","volume":"5","author":"Banks","year":"1999","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1111\/j.1365-2036.2004.02060.x","article-title":"Review article: Treatment of perianal fistulizing Crohn\u2019s disease","volume":"20","author":"Rutgeerts","year":"2004","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/s00384-015-2390-8","article-title":"Crohn\u2019s disease: Is there any link between anal and luminal phenotypes?","volume":"31","author":"Wallenhorst","year":"2016","journal-title":"Int. J. Color. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1002\/ibd.21261","article-title":"Nonfistulizing perianal Crohn\u2019s disease: Clinical features, epidemiology, and treatment","volume":"16","author":"Bouguen","year":"2010","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1002\/ibd.21674","article-title":"Perianal Crohn\u2019s disease findings other than fistulas in a population-based cohort","volume":"18","author":"Loftus","year":"2012","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1097\/DCR.0b013e31825228b0","article-title":"The spectrum of perianal crohn\u2019s disease in a population-based cohort","volume":"55","author":"Eglinton","year":"2012","journal-title":"Dis. Colon Rectum"},{"key":"ref_16","first-page":"254","article-title":"Perianal Crohn\u2019s disease: Clinical implications, prognosis and use of resources","volume":"114","author":"Salado","year":"2022","journal-title":"Rev. Esp. Enferm Dig."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1093\/ecco-jcc\/jjad038","article-title":"Diagnosis and Clinical Features of Perianal Lesions in Newly Diagnosed Crohn\u2019s Disease: Subgroup Analysis from Inception Cohort Registry Study of Patients with Crohn\u2019s Disease (iCREST-CD)","volume":"17","author":"Yamamoto","year":"2023","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1586\/eci.09.76","article-title":"Clinical factors predicting disease course in Crohn\u2019s disease","volume":"6","author":"Eglinton","year":"2010","journal-title":"Expert Rev. Clin. Immunol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1055\/s-0039-1687834","article-title":"Perianal Crohn\u2019s Disease","volume":"32","author":"Pogacnik","year":"2019","journal-title":"Clin. Colon Rectal Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1016\/j.dld.2007.07.154","article-title":"The natural history of perianal Crohn\u2019s disease","volume":"39","author":"Ingle","year":"2007","journal-title":"Dig. Liver Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1097\/00042737-199703000-00004","article-title":"siproudhis1997","volume":"9","author":"Siproudhis","year":"1997","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1007\/DCR.0b013e3181a0a5bf","article-title":"Perineal Crohn\u2019s disease: An indicator of poor prognosis and potential proctectomy","volume":"52","author":"Figg","year":"2009","journal-title":"Dis. Colon Rectum"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1080\/00365521.2018.1437928","article-title":"Perianal Crohn\u2019s disease\u2013association with significant inflammatory activity in proximal small bowel segments","volume":"53","author":"Xavier","year":"2018","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1007\/BF02253493","article-title":"Clinical Classification of Perianal Crohn\u2019s Disease","volume":"35","author":"Hughes","year":"1992","journal-title":"Dis. Colon Rectum"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"5371","DOI":"10.3748\/wjg.v23.i29.5371","article-title":"Elaboration and validation of Crohn\u2019s disease anoperineal lesions consensual definitions","volume":"23","author":"Horaist","year":"2017","journal-title":"World J. Gastroenterol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1097\/00004836-199501000-00008","article-title":"Usual therapy improves perianal Crohn\u2019s disease as measured by a new disease activity index. McMaster IBD Study Group","volume":"20","author":"Irvine","year":"1995","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_27","first-page":"33","article-title":"Management of complex perianal crohn\u2019s disease","volume":"30","year":"2017","journal-title":"Ann. Gastroenterol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1002\/ibd.20826","article-title":"Assessing the activity of perianal Crohn\u2019s disease: Comparison of clinical indices and computer-assisted anal ultrasound","volume":"15","author":"Losco","year":"2009","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1056\/NEJM199905063401804","article-title":"Infliximab for the treatment of fistulas in patients with Crohn\u2019s Disease","volume":"340","author":"Aniel","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s10151-025-03161-z","article-title":"Time to classify: A narrative and scoping review of the old and the new classifications of perianal Crohn\u2019s disease","volume":"29","author":"Pelly","year":"2025","journal-title":"Tech. Coloproctol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1055\/s-0039-1683907","article-title":"Management of Complex Anorectal and Perianal Crohn\u2019s Disease","volume":"32","author":"Bolshinsky","year":"2019","journal-title":"Clin. Colon Rectal Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1080\/00325481.2015.1023160","article-title":"Perianal crohn\u2019s disease: A review","volume":"127","author":"Juncadella","year":"2015","journal-title":"Postgrad. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2496","DOI":"10.1053\/j.gastro.2021.04.022","article-title":"AGA Clinical Practice Guidelines on the Medical Management of Moderate to Severe Luminal and Perianal Fistulizing Crohn\u2019s Disease","volume":"160","author":"Feuerstein","year":"2021","journal-title":"Gastroenterology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1016\/0002-9610(80)90048-3","article-title":"Natural History of Perianal Crohn\u2019s Disease Ten Year Follow-Up: A Plea for Conservatism","volume":"140","author":"Buchmann","year":"1980","journal-title":"Am. J. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"jjaf106","DOI":"10.1093\/ecco-jcc\/jjaf106","article-title":"ECCO-ESGAR-ESP-IBUS Guideline on Diagnostics and Monitoring of Patients with Inflammatory Bowel Disease: Part 1","volume":"19","author":"Kucharzik","year":"2025","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1016\/j.crohns.2013.02.020","article-title":"Imaging techniques for assessment of inflammatory bowel disease: Joint ECCO and ESGAR evidence-based consensus guidelines","volume":"7","author":"Panes","year":"2013","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1016\/j.dld.2014.08.003","article-title":"Magnetic resonance imaging and clinical assessments for perianal Crohn\u2019s disease: Gain and limits","volume":"46","author":"Garros","year":"2014","journal-title":"Dig. Liver Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/s11894-012-0243-y","article-title":"Managing Perianal Crohn\u2019s disease","volume":"14","author":"Wiese","year":"2012","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/BF01649703","article-title":"The histology of anal skin tags in Crohn\u2019s disease: An aid to confirmation of the diagnosis","volume":"4","author":"Taylor","year":"1989","journal-title":"Int. J. Colorectal Dis."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1007\/s10151-017-1684-y","article-title":"Crohn\u2019s disease: French recommendations for clinical practice","volume":"21","author":"Bouchard","year":"2017","journal-title":"Tech. Coloproctol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1002\/ibd.20458","article-title":"Anal skin tags in inflammatory bowel disease: New observations and a clinical review","volume":"14","author":"Bonheur","year":"2008","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"090","DOI":"10.1055\/s-0033-1348047","article-title":"Surgical treatment of anorectal crohn disease","volume":"26","author":"Lewis","year":"2013","journal-title":"Clin. Colon Rectal Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1007\/BF02048328","article-title":"Anal Fissure in Crohn\u2019s Disease: A Plea For Aggressive Management","volume":"38","author":"Fleshner","year":"1995","journal-title":"Dis. Colon Rectum"},{"key":"ref_44","first-page":"129","article-title":"Medical and surgical management of perianal crohn\u2019s disease","volume":"31","author":"Adegbola","year":"2018","journal-title":"Ann. Gastroenterol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1111\/j.1365-2036.2009.04089.x","article-title":"Long-term outcome of non-fistulizing (ulcers, stricture) perianal Crohn\u2019s disease in patients treated with infliximab","volume":"30","author":"Bouguen","year":"2009","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1016\/j.dld.2017.07.014","article-title":"Anal ulcerations in Crohn\u2019s disease: Natural history in the era of biological therapy","volume":"49","author":"Wallenhorst","year":"2017","journal-title":"Dig. Liver Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1016\/j.suc.2019.08.012","article-title":"Anorectal Crohn\u2019s Disease","volume":"99","author":"Truong","year":"2019","journal-title":"Surg. Clin. N. Am."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1016\/j.dld.2007.07.157","article-title":"Surgical therapy of perianal Crohn\u2019s disease","volume":"39","author":"Singh","year":"2007","journal-title":"Dig. Liver Dis."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1007\/BF02049859","article-title":"Surgery for Symptomatic Hemorrhoids and Anal Fissures in Crohn\u2019s Disease","volume":"36","author":"Wolkomir","year":"1993","journal-title":"Dis. Colon Rectum"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1053\/j.gastro.2013.04.048","article-title":"Early administration of azathioprine vs conventional management of Crohn\u2019s disease: A randomized controlled trial","volume":"145","author":"Cosnes","year":"2013","journal-title":"Gastroenterology"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1056\/NEJMoa0904492","article-title":"Infliximab, Azathioprine, or Combination Therapy for Crohn\u2019s Disease","volume":"362","author":"Sandborn","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_52","first-page":"571","article-title":"Combination ciprofloxacin and metronidazole in severe perianal Crohn\u2019s disease","volume":"7","author":"Solomon","year":"1992","journal-title":"Can. J. Gastroenterol. Hepatol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1002\/bjs.7121","article-title":"Randomized clinical trial of metronidazole ointment versus placebo in perianal Crohn\u2019s disease","volume":"97","author":"Maeda","year":"2010","journal-title":"Br. J. Surg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1007\/s10350-004-0873-8","article-title":"Efficacy of topical metronidazole (10 percent) in the treatment of anorectal Crohn\u2019s disease","volume":"48","author":"Stringer","year":"2005","journal-title":"Dis. Colon Rectum"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1002\/ibd.20073","article-title":"Topical tacrolimus in the treatment of perianal Crohn\u2019s disease: Exploratory randomized controlled trial","volume":"13","author":"Hart","year":"2007","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1007\/BF02054120","article-title":"Hyperbaric Oxygenation in Severe Perineal Crohn\u2019s Disease","volume":"38","author":"Colombel","year":"1995","journal-title":"Dis. Colon Rectum"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1111\/j.1572-0241.1999.00848.x","article-title":"Hyperbaric Oxygen Therapy for Perineal Crohn\u2019s Disease","volume":"94","author":"Noyer","year":"1999","journal-title":"Am. J. Gastroenterol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1590\/S0102-86502016001300005","article-title":"Adjunctive hyperbaric oxygen therapy promotes successful healing in patients with refractory crohn\u2019s disease","volume":"31","author":"Feitosa","year":"2016","journal-title":"Acta Cir. Bras."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1007\/BF02058706","article-title":"Perianal Crohn\u2019s Disease Results of Local Surgical Treatment","volume":"39","author":"Sangwan","year":"1996","journal-title":"Dis. Colon Rectum"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1097\/MCG.0b013e3181c21d20","article-title":"Anal Skin Tags: An Overlooked Indicator of Crohn\u2019s Disease","volume":"44","author":"Korelitz","year":"2010","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1136\/gut.25.10.1124","article-title":"Malignant transformation of anal skin tags in Crohn\u2019s disease","volume":"25","author":"Somerville","year":"1984","journal-title":"Gut"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1639","DOI":"10.1097\/DCR.0000000000001834","article-title":"Management of Isolated Anal Strictures in Crohn\u2019s Disease","volume":"63","author":"Lightner","year":"2020","journal-title":"Dis. Colon Rectum"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1002\/bjs.1800750711","article-title":"Natural history and treatment of anorectaI strictures complicating Crohn\u2019s disease","volume":"75","author":"Linares","year":"1988","journal-title":"Br. J. Surg."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1111\/apt.12894","article-title":"Anorectal stricture in 102 patients with Crohn\u2019s disease: Natural history in the era of biologics","volume":"40","author":"Brochard","year":"2014","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_65","first-page":"95","article-title":"The therapeutic dilatation of enteric strictures due to Crohn\u2019s disease Consultant Surgeon Senior Surgical Registrar","volume":"68","author":"Allan","year":"1986","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1067\/msy.2000.108779","article-title":"Surgical treatment of anorectal complications in Crohn\u2019s disease","volume":"128","author":"Michelassi","year":"2000","journal-title":"Surgery"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.gie.2018.09.045","article-title":"Role of interventional inflammatory bowel disease in the era of biologic therapy: A position statement from the Global Interventional IBD Group","volume":"89","author":"Shen","year":"2019","journal-title":"Gastrointest. Endosc."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1007\/s11605-006-0021-y","article-title":"Cytokine network in chronic perianal crohn\u2019s disease and indeterminate colitis after colectomy","volume":"11","author":"Ruffolo","year":"2007","journal-title":"J. Gastrointest. Surg."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.1002\/ibd.20486","article-title":"Cytokine network in rectal mucosa in perianal Crohn\u2019s disease: Relations with inflammatory parameters and need for surgery","volume":"14","author":"Ruffolo","year":"2008","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1093\/ecco-jcc\/jjaa118","article-title":"The incidence and disease course of perianal crohn\u2019s disease: A danish nationwide cohort study, 1997\u20132015","volume":"15","author":"Wewer","year":"2021","journal-title":"J. Crohn\u2019s Colitis"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1016\/j.cgh.2024.05.029","article-title":"Perianal Fistulizing Crohn\u2019s Disease\u2013Associated Anorectal and Fistula Cancers: Systematic Review and Expert Consensus","volume":"23","author":"Wong","year":"2025","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"4260","DOI":"10.3748\/wjg.v30.i39.4260","article-title":"Perianal Crohn\u2019s disease: Still more questions than answers","volume":"30","author":"Swaminathan","year":"2024","journal-title":"World J. Gastroenterol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"3373","DOI":"10.3748\/wjg.v30.i28.3373","article-title":"Perianal disease in inflammatory bowel disease: Broadening treatment and surveillance strategies for anal cancer","volume":"30","author":"Pacheco","year":"2024","journal-title":"World J. Gastroenterol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1046\/j.1463-1318.2003.00510.x","article-title":"Anal and rectal cancer in Crohn\u2019s disease","volume":"5","author":"Myrelid","year":"2003","journal-title":"Color. Dis."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"D\u2019Ugo, S., Franceschilli, L., Cadeddu, F., Leccesi, L., Blanco, G.D.V., Calabrese, E., Milito, G., Di Lorenzo, N., Gaspari, A.L., and Sileri, P. (2013). Medical and surgical treatment of haemorrhoids and anal fissure in Crohn\u2019s disease: A critical appraisal. BMC Gastroenterol., 13.","DOI":"10.1186\/1471-230X-13-47"},{"key":"ref_76","first-page":"839","article-title":"Treatment of hemorrhoids in patients with inflammatory bowel disease","volume":"152","author":"Jeffery","year":"1960","journal-title":"Surg. Gynecol. Obs."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1097\/DCR.0000000000003276","article-title":"The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids","volume":"67","author":"Hawkins","year":"2024","journal-title":"Dis. 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