a Department of Medicine, Division of Gastroenterology , Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai , New York , NY , USA.
Expert Rev Gastroenterol Hepatol. 2018 Jun;12(6):597-605. doi: 10.1080/17474124.2018.1480936. Epub 2018 Jun 4.
Perianal fistulizing disease is an aggressive and debilitating phenotype of Crohn's disease (CD), representing a significant therapeutic challenge. New work has led to advancement in epidemiology and long-term outcomes of perianal disease. The range of therapeutic options continues to expand, including new biologic agents, biosimilars, and stem cell therapy. Areas covered: We discuss updates to all aspects of management of perianal disease, with a focus on the last 3 years of published data. Areas considered include new data on epidemiology and prognostication, medical and surgical therapy, and stem cell therapy. Expert commentary: The presence of perianal disease at CD diagnosis portends a significantly worse disease course. Patients with perianal disease require close monitoring to identify those who are at risk for worsening disease, suboptimal biologic drug levels, and signs of developing neoplasm. With the impending availability of local mesenchymal stem cell therapy, this becomes increasingly important as this therapy, although extremely promising, is thus far only effective in patients without proctitis.
肛周瘘管病是一种侵袭性和使人虚弱的克罗恩病（CD）表型，代表了一个重大的治疗挑战。新的研究工作推动了肛周疾病的流行病学和长期结果的进展。治疗选择的范围继续扩大，包括新的生物制剂、生物类似药和干细胞治疗。
我们讨论了肛周疾病管理的各个方面的最新进展，重点关注过去 3 年发表的数据。考虑的领域包括流行病学和预后的新数据、医学和手术治疗以及干细胞治疗。
CD 诊断时存在肛周疾病预示着疾病过程明显恶化。患有肛周疾病的患者需要密切监测，以识别那些有疾病恶化、生物药物水平不理想以及出现肿瘤迹象风险的患者。随着局部间充质干细胞治疗的即将问世，这一点变得越来越重要，因为这种治疗方法虽然极具前景，但迄今为止仅对没有直肠炎的患者有效。
