Dynamic nature of perianal fistulising Crohn’s disease

Perianal fistulising Crohn’s disease (PFCD) can affect up to one-third of patients with Crohn’s disease (CD). 1 PFCD is recognised as one of the most disabling phenotypes of CD and can manifest with a broad spectrum of symptoms, including pain, discharge and incontinence—all of which significantly reduce quality of life for individuals.2 Beyond symptom severity, PFCD encompasses a diverse range of phenotypes where clinical management—ranging from symptom relief to surgical intervention—is influenced by highly variable patient characteristics, disease features, timing, availability of expertise, expectations and patient preferences. This complexity, which may evolve even within the same patient over time, means that flexible, personalised and multidisciplinary care should be afforded to all patients with PFCD.