title: Medical Therapy of Perianal Crohn's Disease.
abstract: BACKGROUND
  Development of perianal fistulas are a common feature of Crohn's disease (CD). Consequences are severe impairment of quality of life as well as potentially life-threatening complications like abscess formation or bacterial sepsis. Therefore, appropriate treatment is an important task in the management of CD.
  
  
  METHODS
  This review describes the epidemiology, pathogenesis, diagnosis, and conservative medical treatment of perianal CD with regard to the available literature. In February 2015, a PubMed search was performed with the following terms (combined and separate): 'Crohn's disease management', 'Crohn's disease complications', 'perianal Crohn's disease', 'fistulizing Crohn's disease', 'perianal fistulas', 'fistula healing', 'fistula closure'. From the search results, 36 articles were chosen as core elements of this review.
  
  
  RESULTS
  Pelvic magnetic resonance imaging and rectal endosonography are established diagnostic approaches to evaluate perianal fistulas in conjunction with endoscopy. Antibiotics, thiopurines, and calcineurin inhibitors are useful agents in the management of perianal CD. The availability of anti-TNF-alpha therapies has substantially changed the prospects and goals of medical treatment, and fistula healing seems to be possible in a substantial proportion of patients.
  
  
  CONCLUSIONS
  Antibiotics and several immunosuppressive drugs have improved the treatment of fistulizing CD and should be combined with surgical measures.
authors.affiliation: Department of Internal Medicine I, University of Tübingen, Tübingen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Klag
authors.affiliation: Department of Internal Medicine I, University of Tübingen, Tübingen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Goetz
authors.affiliation: Department of Internal Medicine I, Robert-Bosch-Hospital, Stuttgart, Germany.
authors.forename: Eduard F
authors.initials: EF
authors.lastname: Stange
authors.affiliation: Department of Internal Medicine I, University of Tübingen, Tübingen, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Wehkamp
keywords: Anti-TNF-alpha therapy; Crohn's disease; Crohn's disease complications; Inflammatory bowel disease; Perianal fistula