Table 1.

American College of Gastroenterology Clinical Guidelines—Management of Perianal Fistulizing Crohn’s Disease.

Level of recommendation	Level of Evidence	Recommendation
Strong
	Moderate	Infliximab is effective and should be considered in treating perianal fistulas in Crohn’s disease Infliximab may be effective and should be considered in treating enterocutaneous and rectovaginal fistulas in Crohn’s disease Tacrolimus can be administered for short-term treatment of perianal and cutaneous fistulas in Crohn’s disease Antibiotics (imidazoles) may be effective and should be considered in treating simple perianal fistulas The addition of antibiotics to infliximab is more effective than infliximab alone and should be considered in treating perianal fistulas Placement of setons increases the efficacy of infliximab and should be considered in treating perianal fistulas
	Low	Adalimumab and certolizumab pegol may be effective and should be considered in treating perianal fistulas in Crohn’s disease Thiopurines (azathioprine, 6-mercaptopurine) may be effective and should be considered in treating fistulizing Crohn’s disease
Conditional
	Very Low	Drainage of abscesses (surgically or percutaneously) should be undertaken before treatment of fistulizing Crohn’s disease with anti-TNF agents

Adapted from [3].