This piece was designed for gastroenterologists, colorectal surgeons, and other HCPs involved in the diagnosis and management of Crohn’s perianal fistulas (CPF). There is significant uncertainty in the medical community regarding the mechanism of how CPF develops; this piece aims to explain the current consensus in an accessible, engaging format.

The film details the pathophysiology of Crohn’s perianal fistulas, taking viewers on a journey from intestinal inflammation with Crohn’s disease to formation of Crohn’s perianal fistulas. The journey starts outside the body of a patient with Crohn’s disease, before entering and travelling along the inflamed gastrointestinal tract, a hallmark of Crohn’s disease. From here, the camera enters a site of inflammation where a fistula is beginning to form and delves deep into the epithelial lining at the cellular level. The cellular cascade of events leading to fistula formation is shown, including the role that PAMPs, TNF-alpha and epithelial-to-mesenchymal transition play in perpetuating chronic inflammation and impaired wound healing within the gastrointestinal wall. The journey ends with a fully formed fistula, shown at the cellular level, followed by the camera pulling back to a cut-through shot of the body exposing the overall structure and position of the fistula tract.