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Review
. 2023 Jan 6;12(2):466.
doi: 10.3390/jcm12020466.

Crohn's Disease-Associated and Cryptoglandular Fistulas: Differences and Similarities

Zhou Zhou  1 , Laura F Ouboter  1   2 , Koen C M J Peeters  3 , Lukas J A C Hawinkels  1 , Fabian Holman  3 , Maria F Pascutti  2 , Marieke C Barnhoorn  1 , Andrea E van der Meulen-de Jong  1
Affiliations
Review

Crohn's Disease-Associated and Cryptoglandular Fistulas: Differences and Similarities

Zhou Zhou et al. J Clin Med. .

Abstract

Perianal fistulas are defined as pathological connections between the anorectal canal and the perianal skin. Most perianal fistulas are cryptoglandular fistulas, which are thought to originate from infected anal glands. The remainder of the fistulas mainly arises as complications of Crohn's disease (CD), trauma, or as a result of malignancies. Fistulas in CD are considered as a consequence of a chronic and transmural inflammatory process in the distal bowel and can, in some cases, even precede the diagnosis of CD. Although both cryptoglandular and CD-associated fistulas might look similar macroscopically, they differ considerably in their complexity, treatment options, and healing rate. Therefore, it is of crucial importance to differentiate between these two types of fistulas. In this review, the differences between CD-associated and cryptoglandular perianal fistulas in epidemiology, pathogenesis, and clinical management are discussed. Finally, a flow chart is provided for physicians to guide them when dealing with patients displaying their first episode of perianal fistulas.

Keywords: Crohn’s disease; clinical practice; cryptoglandular fistulas; differences and similarities; perianal fistulas.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The classification of perianal fistulas. Parks classification: A. intersphincteric fistulas; B. transsphincteric fistulas; C. suprasphincteric fistulas; D. extrasphincteric fistulas. St James’s University Hospital classification: Grade 1. simple linear intersphincteric fistulas; Grade 2. intersphincteric fistulas with abscesses; Grade 3. transsphincteric fistulas; Grade 4. transsphincteric fistulas with abscesses; Grade 5. supralevator and translevator fistulas. Garg’s classification: I. low liner intersphincteric and transsphincteric fistulas; II. low intersphincteric and transsphincteric fistulas; III. high liner transsphincteric fistulas; IV. complex high transsphincteric fistulas; V. suprasphincteric infralevator fistulas.
Figure 2
Figure 2
Proposed mechanism of the pathogenesis of CD-associated perianal fistulas and cryptoglandular perianal fistulas. EMT: epithelial-mesenchymal transition; TGF-β: transforming growth factor beta; IL-13: interleukin 13; TNF: tumor necrosis factor; IL-1β: interleukin 1 beta; MMPs: matrix metalloproteinases.
Figure 3
Figure 3
Flow chart to deal with a patient displaying his/her first episode of perianal fistulas. PF: perianal fistula; CD-PF: CD-associated perianal fistula. *: No CD-associated symptoms, no IMDs, and no IBD relatives. #: CD-associated symptoms, or/and IMDs, or/and IBD relatives. **: no intestinal inflammation. ##: intestinal inflammation. $: within one year. FCP: fecal calprotectin; MRI: magnetic resonance imaging.
See this image and copyright information in PMC

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