Management and Treatment of Perianal Fistulizing Crohn’s Disease

Abstract

Perianal fistulizing Crohn’s disease is a severe and disabling phenotype of Crohn’s disease, affecting up to one-third of Crohn’s patients. This phenotype can result in significant quality of life impairment in quality of life due to chronic pain, persistent perianal drainage, and the risk of fecal incontinence. The presence of a perianal fistula indicates a more aggressive disease course, often requiring more frequent and coordinated care. Optimal management relies on a multidisciplinary team, including gastroenterologists, colorectal surgeons, and radiologists, to address the complex interplay of medical and surgical needs. Medical therapy achieves durable remission in only about one-third of patients, necessitating surgical intervention for the majority, with patients arriving to the operating room with more advanced disease activity and longer duration of immunosuppression. For patients with refractory disease, mesenchymal stem cell (MSC) therapy has emerged as a promising option, with clinical remission rates of approximately 50–80% at 6–12 months and a favorable safety profile, notably without increasing the risk of incontinence compared to conventional surgery. However, there is no approved MSC product currently available for clinical use. Given the complexity and morbidity of fistulizing perianal Crohn’s disease, a multidisciplinary approach focused on individualized, evidence-based therapy is essential for optimizing outcomes.