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DOP055 Results of the Fifth Scientific Workshop of the ECCO (II): clinical aspects of perianal fistulising Crohn's disease – the unmet needs

Gecse K.*1, Sebastian S.2, De Hertogh G.3, Yassin N.4, Kotze P.5, Reinisch W.6, Spinelli A.7, Koutroubakis I.8, Katsanos K.9, Hart A.10, van den Brink G.11, Rogler G.12, Bemelman W.13

1Semmelweis University, First Department of Medicine, Budapest, Hungary 2Hull & East Yorkshire NHS Trust, Inflammatory Bowel Disease Unit, Hull, United Kingdom 3University of Leuven, Department of Pathology, Leuven, Belgium 4St Mark's Hospital and Academic Institute, Department of Colorectal Surgery, London, United Kingdom 5Catholic University of Paraná, Colorectal Surgery Unit, Curitiba, Brazil 6Medical University of Vienna, Department of Gastroenterology, Vienna, Austria 7Humanities University, Colorectal Surgery Unit, Humanitas Research Hospital, Milano, Italy 8University Hospital Heraklion, Department of Gastroenterology, Heraklion, Greece 9School of Health Sciences, Division of Gastroenterology, Department of Medicine, Ioannia, Greece 10St. Mark's Hospital, Inflammatory Bowel Disease Unit, London, United Kingdom 11Academic Medical Centre, University of Amsterdam, Department of Gastroenterology, Amsterdam, Netherlands 12University Hospital Zurich, Division of Gastroenterology and Hepatology, Zurich, Switzerland 13Academic Medical Centre, University of Amsterdam, Department of Surgery, Amsterdam, Netherlands

Background

Perianal fistulas affect up to one third of Crohn's patients during the course of their disease. Despite the considerable disease burden, current treatment options remain unsatisfactory. The fifth scientific workshop (SWS5) of the European Crohn's and Colitis Organization (ECCO) focused on the pathophysiology and clinical impact of fistulas in the disease course of patients with Crohn's disease (CD).

Methods

Whereas one working group of SWS5 focused on pathophysiology, the ECCO SWS5 Working Group on clinical aspects of perianal fistulising Crohn's disease (pCD) consisted of 13 participants, gastroenterologists, colorectal surgeons and a histopathologist, with expertise in the field of inflammatory bowel diseases. A systematic review of literature was performed.

Results

Four main areas of interest were identified: natural history of pCD, morphological description of fistula tracts, outcome measures (including clinical and patient-reported outcome measures, as well as MR imaging) and randomized controlled trials on pCD.

Conclusion

The treatment of perianal fistulising Crohn's disease remains a multidisciplinary challenge. To optimise management a reliable classification and proper trial endpoints are needed. This could lead to standardized diagnosis, treatment and follow-up of Crohn's perianal fistulas and the execution of well-designed trials that provide clear answers. The prevalence and the natural history of pCD needs further evaluation.