title: Results of the Fifth Scientific Workshop of the ECCO [II]: Clinical Aspects of Perianal Fistulising Crohn's Disease-the Unmet Needs.
abstract: OBJECTIVE
  Perianal fistulas affect up to one-third of Crohn's patients during the course of their disease. Despite the considerable disease burden, current treatment options remain unsatisfactory. The Fifth Scientific Workshop [SWS5] of the European Crohn's and Colitis Organisation [ECCO] focused on the pathophysiology and clinical impact of fistulas in the disease course of patients with Crohn's disease [CD].
  
  
  METHODS
  The ECCO SWS5 Working Group on clinical aspects of perianal fistulising Crohn's disease [pCD] consisted of 13 participants, gastroenterologists, colorectal surgeons, and a histopathologist, with expertise in the field of inflammatory bowel diseases. A systematic review of literature was performed.
  
  
  RESULTS
  Four main areas of interest were identified: natural history of pCD, morphological description of fistula tracts, outcome measures [including clinical and patient-reported outcome measures, as well as magnetic resonance imaging] and randomised controlled trials on pCD.
  
  
  CONCLUSIONS
  The treatment of perianal fistulising Crohn's disease remains a multidisciplinary challenge. To optimise management, a reliable classification and proper trial endpoints are needed. This could lead to standardised diagnosis, treatment, and follow-up of Crohn's perianal fistulas and the execution of well-designed trials that provide clear answers. The prevalence and the natural history of pCD need further evaluation.
authors.affiliation: First Department of Medicine, Semmelweis University, Budapest, Hungary krisztina.gecse@gmail.com.
authors.forename: Krisztina B
authors.initials: KB
authors.lastname: Gecse
authors.affiliation: Inflammatory Bowel Disease Unit, Hull & East Yorkshire NHS Trust, Hull, UK.
authors.forename: Shaji
authors.initials: S
authors.lastname: Sebastian
authors.affiliation: Department of Pathology, University of Leuven, Leuven, Belgium.
authors.forename: Gert de
authors.initials: Gd
authors.lastname: Hertogh
authors.affiliation: Department of Colorectal Surgery, St Mark's Hospital and Academic Institute, London, UK.
authors.forename: Nuha A
authors.initials: NA
authors.lastname: Yassin
authors.affiliation: Colorectal Surgery Unit, Catholic University of Paraná, Curitiba, PR, Brazil.
authors.forename: Paulo G
authors.initials: PG
authors.lastname: Kotze
authors.affiliation: Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: Walter
authors.initials: W
authors.lastname: Reinisch
authors.affiliation: Colorectal Surgery Unit, Humanitas Research Hospital, Humanitas University, Milan, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Spinelli
authors.affiliation: Department of Gastroenterology, University Hospital Heraklion, Iraklio, Greece.
authors.forename: Ioannis E
authors.initials: IE
authors.lastname: Koutroubakis
authors.affiliation: Division of Gastroenterology, Department of Medicine, School of Health Sciences, Ioannina, Greece.
authors.forename: Konstantinos H
authors.initials: KH
authors.lastname: Katsanos
authors.affiliation: Inflammatory Bowel Disease Unit, St Mark's Hospital, London, UK.
authors.forename: Ailsa
authors.initials: A
authors.lastname: Hart
authors.affiliation: Department of Gastroenterology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Gijs R
authors.initials: GR
authors.lastname: van den Brink
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Rogler
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Willem A
authors.initials: WA
authors.lastname: Bemelman
mesh_terms: D003424:Crohn Disease / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D017063:Outcome Assessment, Health Care / Q000379:methods; D012003:Rectal Fistula / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D012720:Severity of Illness Index
keywords: Crohn’s disease; perianal fistula; treatment