Abstract：
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
目的：肛周瘘是克罗恩病的一种具有挑战性的表型，对生活质量有重大影响。历史上,瘘管在解剖学上与括约肌复合体有关，管理指南已经泛化，缺乏对临床异质性的关注。最近的“TOpClass分类系统”用于肛周吻合克罗恩病（PFCD）解决了这个问题，并将患者分为确定的组，这提供了与疾病特征和患者目标相一致的瘘管管理的重点。在这篇文章中,我们讨论了TOpClass模型的临床适用性，并为其在临床实践中的使用提供了指导。
方法：一组国际肛周临床医生参与了一项专家共识，以确定如何将TOpClass系统纳入现实生活中。这包括胃肠病学家，IBD外科医生,和专门从事PFCD的放射科医生。北美八个高容量瘘管病中心的多学科团队管理为这一过程提供了信息，欧洲,和澳大利亚。
结果：该过程产生了职位陈述，以伴随分类系统并指导PFCD管理。陈述范围从静止的肛周疾病患者的管理到需要分流造口术和/或前切除术的严重PFCD患者。医学疗法的优化，以及手术的使用，在瘘管闭合和症状管理方面,我们对每个分类组进行了探讨.
结论：本文概述了该系统在临床实践中的应用。它的目的是使临床医生有一个务实的和患者目标为中心的方法，以医疗和外科管理选择PFCD的个体患者。
方法：一组国际肛周临床医生参与了一项专家共识，以确定如何将TOpClass系统纳入现实生活中。这包括胃肠病学家，IBD外科医生,和专门从事PFCD的放射科医生。北美八个高容量瘘管病中心的多学科团队管理为这一过程提供了信息，欧洲,和澳大利亚。
结果：该过程产生了职位陈述，以伴随分类系统并指导PFCD管理。陈述范围从静止的肛周疾病患者的管理到需要分流造口术和/或前切除术的严重PFCD患者。医学疗法的优化，以及手术的使用，在瘘管闭合和症状管理方面,我们对每个分类组进行了探讨.
结论：本文概述了该系统在临床实践中的应用。它的目的是使临床医生有一个务实的和患者目标为中心的方法，以医疗和外科管理选择PFCD的个体患者。
