Fistulising perianal Crohn’s disease (pCD) is an aggressive phenotype, and patients not
only suffer from perianal manifestations but also a worsening course for their luminal disease. This
article describes the 6 key steps clinicians need to consider when managing patients with pCD which
include; (i) ensuring a prompt diagnosis, (ii) multi-disciplinary management, (iii) psychological support,
(iv) using multimodal medical and surgical treatment strategies, (v) continually monitoring and
optimising therapy and (vi) ensuring that patients have a way of accessing care if required. Patients
with fistulising pCD often have an unpredictable disease course and complete remission can be elusive.
As such, a considered and nuanced approach is essential keeping the wider multi-disciplinary
team and the patient involved in all decision making.