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Gastroenterology

Perianal Crohn's disease: the experience of taking a multiprofessional approach in a tertiary centre setting

17 April 2025
Focus
02 April 2025
Volume 34 · Issue 8
The experience of taking a multiprofessional approach in a tertiary centre setting

Abstract

Perianal fistulising Crohn's disease (PFCD) is a debilitating phenotype of Crohn's disease, with a lifetime incidence of 20–30% in people living with the dieases. Symptoms include perianal pain, perianal discharge and faecal incontinence, with repercussions for a patient's physical and mental health, psychosocial wellbeing and productivity. PFCD is challenging to treat, with existing therapeutic options achieving modest fistula remission rates only. While research initiatives are under way to characterise PFCD pathogenesis and optimal treatment approaches, the focus should be on early diagnosis and prompt management. This can be achieved with patient education, effective co-ordination of care within the multidisciplinary team and an accessible inflammatory bowel disease (IBD) service. IBD specialist nurses may be the first health professionals to encounter a patient with a new diagnosis of PFCD or its complications. This review article summarises the existing evidence relating to clinical aspects of PFCD from a multiprofessional perspective and discusses the role of a dedicated IBD surgical link nurse in PFCD management in a tertiary centre setting.

Crohn's disease is an immune-mediated inflammatory disease of the gastrointestinal tract that can affect any region between the oral cavity to the anus. Symptoms are heterogenous and influenced by the site(s) affected, with the most common being the colon and terminal ileum (Torres et al, 2017). In 1938, the US gastroenterologist, Dr Burrill Bernard Crohn, described an association between regional ileitis and perianal fistula, representing one of the earliest publications of perianal fistulising Crohn's disease (PFCD) as a disease entity (Penner and Crohn, 1938). Despite this early observation, PFCD is most strongly associated with colonic involvement and particularly with proctitis (Kaur et al, 2016; Pogacnik and Salgado, 2019). Perianal fistula may be the first manifestation of Crohn's disease in 10% of patients (Munster et al, 2024).

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Crohn's disease
Fistulising
Perianal
Surgical link nurse
Tertiary centre