Perianal Crohn's Disease-A Gastroenterologist's Perspective

Perianal Crohn's disease is a potentially devastating phenotype of Crohn's disease that can have a significant adverse impact on the life of affected patients. Patients typically suffer from persistent purulent drainage, vaginal or rectal pain, and incontinence. The course is one of frequent relapses and long episodes of actively draining fistulas. Perianal disease can be categorized as fistulizing and nonfistulizing. Nonfistulizing disease includes skin tags or anal canal abnormalities, such as stenosis, fissures, and ulcers. Fistulizing disease is more complex to categorize and treat. Available medical therapies have not appeared to thwart the progression of disease. A majority of patients with fistulizing Crohn's disease will have to undergo operative intervention during the course of their disease. Introduction of antitumor necrosis factor antibodies has been the most promising and effective therapeutic option to date, although its effect on the natural history of the disease remains to be determined.