Cho WonKyung J, Wong Serre-Yu
Department of Medicine, Long Island Jewish Forest Hills, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health System, Forest Hills, NY, USA.
The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1069, New York, NY, 10029, USA.
Curr Gastroenterol Rep. 2025 Jun 27;27(1):46. doi: 10.1007/s11894-025-00998-0.
Perianal fistulizing Crohn's disease (PFCD) is a severe and debilitating phenotype of Crohn's disease that presents significant clinical and therapeutic challenges. This review aims to outline a practical approach to classification and management, emphasizing the utility of the TOpClass system.
The TOpClass classification incorporates clinical and anatomic characteristics to assess severity, treatment options, and patient-clinician goals. Post-hoc analyses from clinical trials for the Janus kinase inhibitor Upadacitinib and emerging data on IL-23 receptor antagonists suggest potential roles beyond anti-TNFs, while the broader use of mesenchymal stem cell therapy remains limited due to inconsistent efficacy. Fistula conditioning with curettage and internal opening closure-an underutilized technique-alongside adjunctive therapies such as hyperbaric oxygen therapy (HBOT), has shown promise in promoting wound healing in select patients. The TOpClass classification, by integrating patient-centered factors and multidisciplinary management, offers a comprehensive and adaptable framework for PFCD, addressing key gaps in treatment planning, standardization, and research. The classification will enable tailored, evidence-based care across the disease spectrum.
肛周瘘管型克罗恩病（PFCD）是克罗恩病的一种严重且使人衰弱的表型，带来了重大的临床和治疗挑战。本综述旨在概述一种实用的分类和管理方法，强调TOpClass系统的实用性。
TOpClass分类纳入临床和解剖学特征以评估严重程度、治疗选择及患者与临床医生的目标。针对Janus激酶抑制剂乌帕替尼的临床试验的事后分析以及关于白细胞介素-23受体拮抗剂的新数据表明，其作用可能超越抗TNF药物，而间充质干细胞疗法因疗效不一致，其广泛应用仍然受限。瘘管刮除术和内口闭合术（一种未充分利用的技术）与高压氧治疗（HBOT）等辅助疗法相结合，已显示出在特定患者中促进伤口愈合的前景。TOpClass分类通过整合以患者为中心的因素和多学科管理，为PFCD提供了一个全面且可适应的框架，填补了治疗规划、标准化和研究方面的关键空白。该分类将实现全疾病谱的个性化、循证治疗。
