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Volume 16
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10.3390/life16010182
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Review

Perianal Crohn’s Disease in Inflammatory Bowel Disease: Diagnosis, Assessment and Treatment

by
Ilaria Faggiani
1,
Isabel Lagos Villaseca
2,
Ferdinando D’Amico
1,
Federica Furfaro
1,
Alessandra Zilli
1,
Sara Massironi
1,
Tommaso Lorenzo Parigi
1,
Virginia Solitano
1,
Clelia Cicerone
1,
Laurent Peyrin-Biroulet
3,
Silvio Danese
1 and
Mariangela Allocca
1,*
1
Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, 20132 Milan, Italy
2
Department of Gastroenterology, Clinica Las Condes, Santiago 7550000, Chile
3
Department of Gastroenterology, INFINY Institute, INSERM NGERE, CHRU Nancy, F-54500 Vandoeuvre-lès-Nancy, France
*
Author to whom correspondence should be addressed.
Life 2026, 16(1), 182; https://doi.org/10.3390/life16010182
Submission received: 31 December 2025 / Revised: 19 January 2026 / Accepted: 21 January 2026 / Published: 22 January 2026
(This article belongs to the Section Medical Research)
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Abstract

Perianal fistulizing Crohn’s disease (pfCD) represents one of the most challenging manifestations of CD, often associated with severe phenotypes, refractory luminal inflammation, and a substantial reduction in quality of life. Its pathogenesis is multifactorial and incompletely understood, involving genetic susceptibility, epithelial and stromal dysfunction, and microbiome-related mechanisms. Diagnosis and monitoring rely on advanced imaging, while management requires coordinated medical–surgical strategies. Significant unmet needs persist regarding standardized treatment targets, optimal imaging follow-up, and personalized therapeutic pathways. In this review, we aim to summarise and provide a comprehensive overview of the most recent evidence across pathogenesis, diagnosis, classification systems, and therapeutic approaches in pfCD. We highlight key advances in understanding epithelial–mesenchymal transition, immune–microbiome interactions, and genetic determinants of disease behaviour. Improvements in diagnostic modalities—including MRI-based scores, ultrasound technologies, volumetric assessment, and AI-enhanced imaging—are discussed alongside modern classification systems such as TOPClass. Evidence guiding medical therapy, seton management, and surgical decision-making is reviewed, emphasising integrated, goal-oriented care. Despite substantial progress, pfCD remains a difficult-to-treat condition with persistent gaps in early diagnosis, objective monitoring, and individualized management. Emerging imaging technologies, standardized treatment targets, and structured classification frameworks offer promising strategies to overcome current limitations and improve long-term outcomes.
Keywords: perianal disease; Crohn’s disease; inflammatory bowel disease perianal disease; Crohn’s disease; inflammatory bowel disease

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MDPI and ACS Style

Faggiani, I.; Villaseca, I.L.; D’Amico, F.; Furfaro, F.; Zilli, A.; Massironi, S.; Parigi, T.L.; Solitano, V.; Cicerone, C.; Peyrin-Biroulet, L.; et al. Perianal Crohn’s Disease in Inflammatory Bowel Disease: Diagnosis, Assessment and Treatment. Life 2026, 16, 182. https://doi.org/10.3390/life16010182

AMA Style

Faggiani I, Villaseca IL, D’Amico F, Furfaro F, Zilli A, Massironi S, Parigi TL, Solitano V, Cicerone C, Peyrin-Biroulet L, et al. Perianal Crohn’s Disease in Inflammatory Bowel Disease: Diagnosis, Assessment and Treatment. Life. 2026; 16(1):182. https://doi.org/10.3390/life16010182

Chicago/Turabian Style

Faggiani, Ilaria, Isabel Lagos Villaseca, Ferdinando D’Amico, Federica Furfaro, Alessandra Zilli, Sara Massironi, Tommaso Lorenzo Parigi, Virginia Solitano, Clelia Cicerone, Laurent Peyrin-Biroulet, and et al. 2026. "Perianal Crohn’s Disease in Inflammatory Bowel Disease: Diagnosis, Assessment and Treatment" Life 16, no. 1: 182. https://doi.org/10.3390/life16010182

APA Style

Faggiani, I., Villaseca, I. L., D’Amico, F., Furfaro, F., Zilli, A., Massironi, S., Parigi, T. L., Solitano, V., Cicerone, C., Peyrin-Biroulet, L., Danese, S., & Allocca, M. (2026). Perianal Crohn’s Disease in Inflammatory Bowel Disease: Diagnosis, Assessment and Treatment. Life, 16(1), 182. https://doi.org/10.3390/life16010182

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