Deep remission on magnetic resonance imaging impacts outcomes of perianal fistulizing Crohn’s disease

Abstract Background The long-term management of perianal Crohn’s disease for patients on anti-TNF-α therapy remains challenging. Aim To evaluate the long-term course and complications of patients with perianal fistulas treated with anti-TNF-α based on their clinical remission and healing on MRI. Methods Patients were evaluated clinically and by MRI. Deep remission was defined as clinical remission associated with the absence of contrast enhancement and T2 hyperintensity on MRI. Flare-free survival, surgery and hospitalizations were compared based on the presence or not of deep remission. Results Forty-eight consecutive patients were included with a median follow-up of 62 months after anti-TNF-α first administration. Deep remission was observed in 16 patients (33.4%). For patients in deep remission, the median time to any perianal event was 116 months (95–130) versus 42 months (8–72) in patients with pathological MRI (p  Conclusions Higher flare-free survival and lower rates of surgery and hospitalization were found in patients achieving deep remission.