Hanna Luke N, Anandabaskaran Sulak, Iqbal Nusrat, Geldof Jeroen, LeBlanc Jean-Frédéric, Dige Anders, Lundby Lilli, Vermeire Séverine, D'Hoore André, Verstockt Bram, Bislenghi Gabriele, De Looze Danny, Lobaton Triana, Van de Putte Dirk, Spinelli Antonino, Carvello Michele, Danese Silvio, Buskens Christianne J, Gecse Krisztina, Hompes Roel, Becker Marte, van der Bilt Jarmila, Bemelman Willem, Sebastian Shaji, Moran Gordan, Lightner Amy L, Wong Serre-Yu, Colombel Jean-Frédéric, Cohen Benjamin L, Holubar Stefan D, Ding Nik S, Behrenbruch Corina, Sahnan Kapil, Misra Ravi, Lung Phillip, Hart Ailsa, Tozer Phil
Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom; IBD Unit, St Mark's Hospital, London, United Kingdom.
Department of Gastroenterology, School of Clinical Medicine, St Vincent's Healthcare Clinical Campus, University of New South Wales, Sydney, Australia.
Clin Gastroenterol Hepatol. 2025 May;23(6):914-926. doi: 10.1016/j.cgh.2024.06.047. Epub 2024 Aug 10.
BACKGROUND & AIMS: Perianal fistulation is a challenging phenotype of Crohn's disease, with significant impact on quality of life. Historically, fistulae have been classified anatomically in relation to the sphincter complex, and management guidelines have been generalized, with lack of attention to the clinical heterogenicity seen. The recent 'TOpClass classification system' for perianal fistulizing Crohn's disease (PFCD) addresses this issue, and classifies patients into defined groups, which provide a focus for fistula management that aligns with disease characteristics and patient goals. In this article, we discuss the clinical applicability of the TOpClass model and provide direction on its use in clinical practice.
An international group of perianal clinicians participated in an expert consensus to define how the TOpClass system can be incorporated into real-life practice. This included gastroenterologists, inflammatory bowel disease surgeons, and radiologists specialized in PFCD. The process was informed by the multi-disciplinary team management of 8 high-volume fistula centres in North America, Europe, and Australia.
The process produced position statements to accompany the classification system and guide PFCD management. The statements range from the management of patients with quiescent perianal disease to those with severe PFCD requiring diverting-ostomy and/or proctectomy. The optimization of medical therapies, as well as the use of surgery, in fistula closure and symptom management is explored across each classification group.
This article provides an overview of the system's use in clinical practice. It aims to enable clinicians to have a pragmatic and patient goal-centered approach to medical and surgical management options for individual patients with PFCD.
肛周瘘管形成是克罗恩病具有挑战性的一种表现形式，对生活质量有重大影响。从历史上看，瘘管一直根据与括约肌复合体的关系进行解剖学分类，管理指南也较为笼统，未关注到所观察到的临床异质性。最近用于肛周瘘管性克罗恩病（PFCD）的“TOPClass分类系统”解决了这一问题，将患者分为明确的组，为与疾病特征和患者目标相匹配的瘘管管理提供了重点。在本文中，我们讨论TOPClass模型的临床适用性，并为其在临床实践中的应用提供指导。
一组国际肛周临床医生参与了专家共识，以确定如何将TOPClass系统纳入实际临床实践。这包括胃肠病学家、炎症性肠病外科医生以及专门从事PFCD的放射科医生。该过程参考了北美、欧洲和澳大利亚8个高流量瘘管中心的多学科团队管理经验。
该过程产生了与分类系统配套的立场声明，以指导PFCD的管理。声明内容涵盖从静止期肛周疾病患者的管理到需要进行转流造口术和/或直肠切除术的重度PFCD患者的管理。针对每个分类组，探讨了在瘘管闭合和症状管理中优化药物治疗以及手术的应用。
本文概述了该系统在临床实践中的应用。其目的是使临床医生能够以务实且以患者目标为中心的方法，针对个体PFCD患者的药物和手术管理选项进行决策。
