Gastrointest Endosc Clin N Am. 2022 Oct;32(4):631-650.doi: 10.1016/j.giec.2022.04.003. Epub 2022 Sep 7.

Sarah Householder ¹, Joseph A Picoraro ²

Author information

¹Columbia University Irving Medical Center, New York, NY 10032, USA.

²Columbia University Irving Medical Center, NewYork-Presbyterian Morgan Stanley Children's Hospital, 622 West 168th Street, PH17-105, New York, NY 10032, USA. Electronic address: jp3386@cumc.columbia.edu.

Abstract

Fistula in inflammatory bowel disease (IBD) is a well-known yet poorly understood phenotype. Pathophysiology is largely based on the activation of the epithelial-mesenchymal transition (EMT); however, interactions with the microbiome, genetics, mechanical stress and the presence of stricturing disease, and surgical complications play a role. Perianal penetrating disease represents a more severe phenotype in IBD. Pouch-associated fistula can arise as a result of an anastomotic leak, surgical complications, or Crohn's disease (CD) of the pouch. Classification is site-dependent, includes a range of severity, and informs management. It is important to determine associated symptoms and recognize the complex interplay of underlying etiologies to form the basis of appropriate care.