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.

中文翻译：

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肛周瘘管克罗恩病：在临床实践中利用 TOpClass 分类提供有针对性的个体化护理


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，瘘管在解剖学上根据括约肌复合体进行分类，管理指南也已普遍化，而缺乏对临床异质性的关注。最近针对肛周瘘管克罗恩病 (PFCD) 的“TOPClass 分类系统”解决了这个问题，并将患者分为明确的组，这为符合疾病特征和患者目标的瘘管治疗提供了重点。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使用提供指导。一个由肛周临床医生组成的国际小组参与了专家共识，以确定如何将 TOpClass 系统纳入现实生活实践。其中包括胃肠病学家、炎症性肠病外科医生和专门从事 PFCD 的放射科医生。该流程由北美、欧洲和澳大利亚 8 个大容量瘘管中心的多学科团队管理人员提供信息。该流程生成了立场声明，以配合分类系统并指导 PFCD 管理。这些声明的范围从对静态肛周疾病患者的管理到需要改道造口术和/或直肠切除术的严重 PFCD 患者。每个分类组都探讨了在瘘管闭合和症状管理方面药物治疗的优化以及手术的使​​用。本文概述了该系统在临床实践中的使用。它旨在使临床医生能够采取务实且以患者目标为中心的方法，为 PFCD 患者提供医疗和手术治疗选择。