title: Results of the Fifth Scientific Workshop of the ECCO (II): Pathophysiology of Perianal Fistulizing Disease.
abstract: The fifth scientific workshop of the European Crohn's and Colitis Organization (ECCO) focused on the relevance of fistulas to the disease course of patients with Crohn's disease (CD). The objectives were to reach a better understanding of the pathophysiological mechanisms underlying the formation of CD fistulas; to identify future topics in fistula research that could provide insights into pathogenesis; to develop novel therapeutic approaches; and to review current therapeutic strategies (with clarification of existing approaches to prevention, diagnosis and treatment). The results of the workshop are presented in two separate manuscripts. This manuscript describes current state-of-the-art knowledge about fistula pathogenesis, including the roles of epithelial-to-mesenchymal transition and cytokine matrix remodelling enzymes, and highlights the common association between fistulas and stenosis in CD. The review also considers the possible roles that genetic predisposition and intestinal microbiota play in fistula development. Finally, it proposes future directions and needs for fistula research that might substantially increase our understanding of this complex condition and help unravel novel therapeutic strategies and specific targets for treatment. Overall, it aims to highlight unanswered questions in fistula research and to provide a framework for future research work.
authors.affiliation: Department of Medicine (Gastroenterology, Infectious Diseases, Rheumatology), Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Britta
authors.initials: B
authors.lastname: Siegmund
authors.affiliation: Department of Histopathology, Royal London Hospital, London, UK.
authors.forename: Roger M
authors.initials: RM
authors.lastname: Feakins
authors.affiliation: Academic Department of Gastroenterology, Ethnikon and Kapodistriakon University of Athens, Laikon Hospital, Athens, Greece.
authors.forename: Giorgos
authors.initials: G
authors.lastname: Barmias
authors.affiliation: ESADI Clinic and Gastroenterology Unit, Santa Isabel Hospital, Blumenau, Santa Catarina, Brazil.
authors.forename: Juliano Coelho
authors.initials: JC
authors.lastname: Ludvig
authors.affiliation: Colorectal Unit, Gastrosaude Clinic, Marilia, Sao Paulo, Brazil Department of Surgery, UNESP Botucatu, Sao Paulo, Brazil.
authors.forename: Fabio Vieira
authors.initials: FV
authors.lastname: Teixeira
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Rogler
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland michael.scharl@usz.ch.
authors.forename: Michael
authors.initials: M
authors.lastname: Scharl
mesh_terms: D000818:Animals; D003424:Crohn Disease / Q000150:complications* / Q000473:pathology; D016207:Cytokines / Q000502:physiology; D004493:Education; D058750:Epithelial-Mesenchymal Transition; D005355:Fibrosis; D000069196:Gastrointestinal Microbiome / Q000502:physiology; D020022:Genetic Predisposition to Disease; D006801:Humans; D008099:Liver / Q000473:pathology; D008168:Lung / Q000473:pathology; D012003:Rectal Fistula / Q000209:etiology* / Q000235:genetics / Q000473:pathology
chemical_list: D016207:Cytokines
keywords: Crohn’s disease; Inflammatory bowel disease; cytokines; epithelial-to-mesenchymal transition; fibrosis; fistula; genetic predisposition; intestinal microbiota; mouse models