Медицинская библиотека · Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2026

Evolving patient journey in the management of active perianal fistulizing Crohn's disease: A temporal perspective.

Bak Michiel T J, Verweij Merel M, Stassen Laurents P S, Buskens Christianne J, Pronk Aagje M, van der Bilt Jarmila D W, Munster Liesbeth J, de Boer Nanne K H, Gecse Krisztina B, Pierik Robert-Jan B, Witjes Caroline D M, Fitzpatrick Claire E, Breukink Stephanie O, Pierik Marieke J, Nissen Loes H C, Verdaasdonk Emiel G G, Gilissen Lennard P L, Bloemen Johanne G, Mares Wout G N, de Jong Gabie M, Sikkema Marjolein, Zimmerman David D E, Bierens-Peters Dominique, de Jonge Vincent, Smeenk Robert M, Jharap Bindia J, de Witte Evelien, Romberg-Camps Mariëlle, Bodelier Alexander G L, Ayez Ninos, Vos Xander G, van Herwaarden Margot A, Bos-Poliste Suzan, Indemans Fleur A, van Boeckel Petra G A, Voskuil Michiel D, van der Wouden Egbert-Jan, van Dalsen Annette D, Willemsen-Maas Saskia, Vandebosch Sigrid, van Dessel Els, Adang Rob P R, Konsten Joop L M, van Aalten Sanne M, Wobbes Margriet H, van der Zanden Esmerij P, Veltkamp Sanne C, Pultrum Bareld B, Ter Steege Rinze W F, Tielemans Merel M, van der Have Mike, Zuur Abraham T, Ter Borg Pieter C J, Braat Henri, Aukema Tjeerd S, Stuyt Rogier J L, van Rossem Charles C, Verweij K Evelyne, van Oostendorp Justin Y, Han-Geurts Ingrid, van Tongeren Patricia, Govaert Johannes A, van der Marel Sander, Horjus Carmen S, Jansen Jeroen M, Jansen Sita V, Bloemendaal Alexander L A, West Rachel L, Kortekaas Robert T J, Peeters Koen C M J, van der Meulen-de Jong Andrea E, van Schaik Fiona D M, Richir Milan C, van Dongen Koen W, Duijvestein Marjolijn, Bouwknegt Dianne G, Hoogenboom Froukje J, Visschedijk Marijn C, de Vries Annemarie C, van Ruler Oddeke, Dutch Initiative on Crohn and Colitis (ICC) & Dutch Initiative on Crohn and Colitis‐Surgery (ICC‐S)

СтатьяМногоцентровое исследованиеПеревод в очереди

Аннотация

BACKGROUND

Over recent decades, there has been a more pronounced shift towards earlier therapeutic intervention in luminal Crohn's disease (CD). However, it remains unclear if similar strategies apply to active perianal fistulizing CD (pCD). This study explores the patient journey by assessing pCD management across diagnostic time periods in a large national cohort.

METHODS

Patients with active pCD were included in a multicentre cohort across 41 Dutch academic and non-academic hospitals. Diagnostic modalities, medical and surgical treatments were evaluated over the pCD disease course, particularly within the first year after pCD diagnosis, and compared across four time periods: < 2010, 2010-2015, 2015-2020 and > 2020.

RESULTS

Four hundred and forty patients were included (53.0% female; median pCD disease course 4.1 years). 12% were diagnosed before 2010, 11% in 2010-2015, 31% in 2015-2020, 46% after 2020. Over time, imaging (MRI or EUS) within the first year after pCD diagnosis was used in 37% of cases diagnosed before 2010 to 66%, 83% and 95% in subsequent periods. Endoscopic evaluation for proctitis was performed in 23%, 40%, 57% and 60%. First-line anti-TNF use was initiated in 27% followed by 58%, 68% and 69%. A seton was placed in 27% initially and in 42%, 51% and 52% in later years. Fistula surgery aimed at closure was performed in 14%, 4%, 8% and 19% over time.

CONCLUSIONS

This national cohort illustrates substantial progress in early pCD management over time. These shifts likely reflect growing clinical awareness of the importance of early and multidisciplinary interventions. However, surgical procedures aimed at fistula closure remain infrequently performed in the early disease course, which may be related to the inclusion of a predominantly therapy-refractory patient group.

Для цитирования: Bak Michiel T J, Verweij Merel M, Stassen Laurents P S, Buskens Christianne J, Pronk Aagje M, van der Bilt Jarmila D W, Munster Liesbeth J, de Boer Nanne K H, Gecse Krisztina B, Pierik Robert-Jan B, Witjes Caroline D M, Fitzpatrick Claire E, Breukink Stephanie O, Pierik Marieke J, Nissen Loes H C, Verdaasdonk Emiel G G, Gilissen Lennard P L, Bloemen Johanne G, Mares Wout G N, de Jong Gabie M, Sikkema Marjolein, Zimmerman David D E, Bierens-Peters Dominique, de Jonge Vincent, Smeenk Robert M, Jharap Bindia J, de Witte Evelien, Romberg-Camps Mariëlle, Bodelier Alexander G L, Ayez Ninos, Vos Xander G, van Herwaarden Margot A, Bos-Poliste Suzan, Indemans Fleur A, van Boeckel Petra G A, Voskuil Michiel D, van der Wouden Egbert-Jan, van Dalsen Annette D, Willemsen-Maas Saskia, Vandebosch Sigrid, van Dessel Els, Adang Rob P R, Konsten Joop L M, van Aalten Sanne M, Wobbes Margriet H, van der Zanden Esmerij P, Veltkamp Sanne C, Pultrum Bareld B, Ter Steege Rinze W F, Tielemans Merel M, van der Have Mike, Zuur Abraham T, Ter Borg Pieter C J, Braat Henri, Aukema Tjeerd S, Stuyt Rogier J L, van Rossem Charles C, Verweij K Evelyne, van Oostendorp Justin Y, Han-Geurts Ingrid, van Tongeren Patricia, Govaert Johannes A, van der Marel Sander, Horjus Carmen S, Jansen Jeroen M, Jansen Sita V, Bloemendaal Alexander L A, West Rachel L, Kortekaas Robert T J, Peeters Koen C M J, van der Meulen-de Jong Andrea E, van Schaik Fiona D M, Richir Milan C, van Dongen Koen W, Duijvestein Marjolijn, Bouwknegt Dianne G, Hoogenboom Froukje J, Visschedijk Marijn C, de Vries Annemarie C, van Ruler Oddeke, Dutch Initiative on Crohn and Colitis (ICC) & Dutch Initiative on Crohn and Colitis‐Surgery (ICC‐S). Evolving patient journey in the management of active perianal fistulizing Crohn's disease: A temporal perspective.. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2026. DOI: 10.1111/codi.70613.

Предметные рубрики MeSH

Humans Crohn Disease Female Rectal Fistula Male Adult Netherlands Middle Aged Time Factors Magnetic Resonance Imaging Young Adult Cohort Studies Proctitis

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