Dr Regueiro reviews his presentation from Digestive Disease Week on the treatment of perianal Crohn's disease, including advances in medical therapies and surgical approaches. 

Miguel Regueiro, MD, is professor of medicine and chair of the Digestive Disease Institute at Cleveland Clinic in Cleveland, Ohio.

Perianal Crohn’s Disease — Multidisciplinary Management and Emerging Therapies 

• Condition & severity: Perianal Crohn’s disease is an aggressive, destructive phenotype with higher rates of infection, abscesses, and fistula formation, leading to increased symptoms and morbidity; emphasizes need for structured, data-informed care approach.

• Treatment strategy: Antibiotics alone are insufficient. Optimal outcomes are reported with combined surgical and medical management—specifically seton placement for abscess drainage followed by infliximab therapy, associated with improved patient outcomes versus non-integrated approaches.

• Emerging/adjunct therapies & trial signals: Upadacitinib and guselkumab are now being tested in perianal fistula, showing efficacy for treating perianal CD. Stem cell therapy (Admire II trial) showed negative results, indicating no near-term availability in the United States for fistula treatment.

I'm Miguel Regueiro. I'm the chief of the Digestive Disease Institute and Professor of Medicine at Cleveland Clinic in Cleveland, Ohio. At DDW 2026, I was part of an IBD group of experts that presented different topics and my topic was perianal Crohn's disease.

As we all know, perianal Crohn's disease is one of the more severe conditions in inflammatory bowel disease. Why is that? It seems to be more aggressive, more destructive, meaning patients get more infection, abscesses, more fistula, and this can lead to obviously a number of symptoms and higher morbidities. What we actually described and what I presented today about perianal Crohn's disease is kind of an approach that we now have taken from an accumulation of data over time.

And I think some of the take home messages are antibiotics alone are not enough, that we do need to work with our surgeons very closely in these patients because what our group had found in the past is patients who had a seton to actually drain the abscess, then had a therapy like infliximab did much better.

I also reviewed some newer treatments for perianal fistula aside from infliximab, which has been our tried and true, some upadacitinib data, and then some data that are coming out now with guselkumab. And then finally, I discussed some stem cell work, which we originally were very hopeful about, but the Admire II study was negative. So at least in the United States for a while, stem cells won't be an option for fistula.