Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 May;23(6):914-926.
doi: 10.1016/j.cgh.2024.06.047. Epub 2024 Aug 10.

Perianal Fistulizing Crohn's Disease: Utilizing the TOpClass Classification in Clinical Practice to Provide Targeted Individualized Care

Luke N Hanna  1 , Sulak Anandabaskaran  2 , Nusrat Iqbal  3 , Jeroen Geldof  4 , Jean-Frédéric LeBlanc  5 , Anders Dige  6 , Lilli Lundby  7 , Séverine Vermeire  8 , André D'Hoore  9 , Bram Verstockt  8 , Gabriele Bislenghi  9 , Danny De Looze  4 , Triana Lobaton  4 , Dirk Van de Putte  10 , Antonino Spinelli  11 , Michele Carvello  11 , Silvio Danese  12 , Christianne J Buskens  13 , Krisztina Gecse  14 , Roel Hompes  13 , Marte Becker  14 , Jarmila van der Bilt  13 , Willem Bemelman  13 , Shaji Sebastian  15 , Gordan Moran  16 , Amy L Lightner  17 , Serre-Yu Wong  18 , Jean-Frédéric Colombel  18 , Benjamin L Cohen  19 , Stefan D Holubar  20 , Nik S Ding  21 , Corina Behrenbruch  22 , Kapil Sahnan  3 , Ravi Misra  23 , Phillip Lung  24 , Ailsa Hart  25 , Phil Tozer  3
Affiliations
Free article
Review

Perianal Fistulizing Crohn's Disease: Utilizing the TOpClass Classification in Clinical Practice to Provide Targeted Individualized Care

Luke N Hanna et al. Clin Gastroenterol Hepatol. 2025 May.
Free article

Abstract

Background & aims: 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.

Conclusion: 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.

Keywords: Crohn’s Disease; Multi-disciplinary Management; Perianal Fistula.

PubMed Disclaimer