title: A global consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn's disease.
abstract: OBJECTIVE
  To develop a consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn's disease (pCD), based on best available evidence.
  
  
  METHODS
  Based on a systematic literature review, statements were formed, discussed and approved in multiple rounds by the 20 working group participants. Consensus was defined as at least 80% agreement among voters. Evidence was assessed using the modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria.
  
  
  RESULTS
  Highest diagnostic accuracy can only be established if a combination of modalities is used. Drainage of sepsis is always first line therapy before initiating immunosuppressive treatment. Mucosal healing is the goal in the presence of proctitis. Whereas antibiotics and thiopurines have a role as adjunctive treatments in pCD, anti-tumour necrosis factor (anti-TNF) is the current gold standard. The efficacy of infliximab is best documented although adalimumab and certolizumab pegol are moderately effective. Oral tacrolimus could be used in patients failing anti-TNF therapy. Definite surgical repair is only of consideration in the absence of luminal inflammation.
  
  
  CONCLUSIONS
  Based on a multidisciplinary approach, items relevant for fistula management were identified and algorithms on diagnosis and treatment of pCD were developed.
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Robarts Research Institute, Amsterdam, The Netherlands.
authors.forename: Krisztina B
authors.initials: KB
authors.lastname: Gecse
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: Bemelman
authors.affiliation: St. Vincent's Hospital and University of Melbourne, Melbourne, Australia.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kamm
authors.affiliation: Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: Stoker
authors.affiliation: Robarts Research Institute, London, Ontario, Canada University of Western Ontario, London, Ontario, Canada.
authors.forename: Reena
authors.initials: R
authors.lastname: Khanna
authors.affiliation: Department of Medicine and Therapeutics, Institute of Digestive Disease, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Siew C
authors.initials: SC
authors.lastname: Ng
authors.affiliation: Department of Gastroenterology, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Julián
authors.initials: J
authors.lastname: Panés
authors.affiliation: Department of Gastroenterology, University of Leuven, Leuven, Belgium.
authors.forename: Gert
authors.initials: G
authors.lastname: van Assche
authors.affiliation: Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.
authors.forename: Zhanju
authors.initials: Z
authors.lastname: Liu
authors.affiliation: APRG, Imperial College, London, UK IBD Unit, St. Mark's Hospital, London, UK.
authors.forename: Ailsa
authors.initials: A
authors.lastname: Hart
authors.affiliation: Robarts Research Institute, San Diego, CA, USA Division of Gastroenterology, University of California San Diego, La Jolla, California, USA.
authors.forename: Barrett G
authors.initials: BG
authors.lastname: Levesque
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Robarts Research Institute, Amsterdam, The Netherlands.
authors.forename: Geert
authors.initials: G
authors.lastname: D'Haens
mesh_terms: D000465:Algorithms; D001003:Anal Canal / Q000601:surgery; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003424:Crohn Disease / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D004322:Drainage; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D012003:Rectal Fistula / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012007:Rectum / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents
keywords: Crohn's Disease; Gastrointestinal Fistulae; IBD Clinical; Infliximab