Navigating the complexities of perianal Crohn’s disease: Diagnostic strategies, treatment approaches, and future perspectives

Abstract

This article discusses the literature review article by Pacheco et al published in July 2024; the authors provided good reviews of perianal Crohn’s disease (CD), and challenges faced by clinicians in the management. CD, characterized by its chronic and relapsing nature, is an idiopathic condition that can involve any segment of the gastrointestinal tract. Perianal disease impacts up to 40% of patients with CD, with perianal fistulas constituting up to 80% of perianal lesions. Perianal CD can be highly incapacitating and profoundly diminish the overall well-being of patients. The management focuses on controlling the perianal sepsis and treating luminal CD. Biologics are crucial to the treatment approach, and results have been encouraging. The surgery focuses on controlling the sepsis, with more definitive treatments being fistula surgery, fecal diversion, and proctectomy as the last resort. This manuscript briefly describes the burden of CD, the challenges posed by perianal CD, and the role of different treatment modalities from colorectal surgeon’s perspective.

Keywords: Crohn’s disease; Perianal; Fistula; Fistulotomy; Biologics; Stem cell therapy

Core Tip: Perianal disease affects a significant number of Crohn’s patients. Perianal fistulizing Crohn’s disease can be very debilitating and adversely affect the quality of life. These patients are primarily managed through a multidisciplinary approach. This editorial provides a detailed analysis of current management strategies for perianal diseases in Crohn’s patients and an analysis of the literature by Pacheco et al.