title: What role do bacteria play in persisting fistula formation in idiopathic and Crohn's anal fistula?
abstract: OBJECTIVE
  The aetiology of Crohn's disease-related anal fistula remains obscure. Microbiological, genetic and immunological factors are thought to play a role but are not well understood. The microbiota within anal fistula tracts has never been examined using molecular techniques. The present study aimed to characterize the microbiota in the tracts of patients with Crohn's and idiopathic anal fistula.
  
  
  METHODS
  Samples from the fistula tract and rectum of patients with Crohn's and idiopathic anal fistula were analysed using fluorescent in situ hybridization, Gram staining and scanning electron microscopy were performed to identify and quantify the bacteria present.
  
  
  RESULTS
  Fifty-one patients, including 20 with Crohn's anal fistula, 18 with idiopathic anal fistula and 13 with luminal Crohn's disease and no anal fistula, were recruited. Bacteria were not found in close association with the luminal surface of any of the anal fistula tracts.
  
  
  CONCLUSIONS
  Anal fistula tracts generally do not harbour high levels of mucosa-associated microbiota. Crohn's anal fistulas do not seem to harbour specific bacteria. Alternative explanations for the persistence of anal fistula are needed.
authors.affiliation: The Fistula Research Unit, St Mark's Hospital, London, UK; Antigen Presenting Research Group, Imperial College London, London, UK; Northwick Park Institute for Medical Research, London, UK; School of Medicine Diabetes and Nutritional Sciences Division, King's College London, London, UK; Imperial College London and St Mark's Hospital, London, UK.
authors.forename: P J
authors.initials: PJ
authors.lastname: Tozer
authors.forename: N
authors.initials: N
authors.lastname: Rayment
authors.forename: A L
authors.initials: AL
authors.lastname: Hart
authors.forename: N
authors.initials: N
authors.lastname: Daulatzai
authors.forename: A U
authors.initials: AU
authors.lastname: Murugananthan
authors.forename: K
authors.initials: K
authors.lastname: Whelan
authors.forename: R K S
authors.initials: RK
authors.lastname: Phillips
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000382:microbiology; D003424:Crohn Disease / Q000150:complications* / Q000382:microbiology; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000382:microbiology; D008297:Male; D064307:Microbiota; D008875:Middle Aged; D012003:Rectal Fistula / Q000382:microbiology*
keywords: Crohn's; anal fistula; microbiology