Anal fistula is a common and frequently-occurring disease in anorectal diseases,with perianal pus,pain,and itching as the main symptoms,and young men as the main patients.At present,the pathogenesis of anal fistula is still unclear,and the main treatment is surgery.The prognosis of surgery is closely related to the surgeon's grasp of the inter-nal opening and the protection of the sphincter.In recent years,the study of intestinal flora has become a hot topic,and its role in various diseases has been gradually confirmed.Studies have shown that changes in the bacterial flora and dis-turbance of the intestinal microenvironment are involved in the occurrence of anal fistulas,which are specifically manifes-ted in the increase in the abundance and diversity of bacterial flora and the infection of enterogenic bacteria.Epithelial-mesenchymal transition(EMT)is an important phenotypic change in diseases such as cancer.With the deepening of re-search,it has been proven to be involved in the occurrence and development of anal fistulas,which is especially common in Crohn's disease.Based on the anatomical characteristics and mainstream pathogenesis of anal fistula,this article sum-marizes the correlation between intestinal flora-EMT-anal fistula by sorting out relevant domestic and foreign researches,from the perspective of intestinal flora and anal fistula,intestinal flora and EMT,and expounds the pathogenesis of anal fistula from three aspects:intestinal flora and anal fistula,intestinal flora and EMT,and EMT and anal fistula.It is con-cluded that the formation of anal fistula may be due to changes in intestinal flora that affect the homeostasis of the intesti-nal mucosal barrier,thereby inducing the occurrence of EMT and participating in the development of inflammation-in-duced fibrosis and fistulas.Since there are few studies on EMT and cryptoglandular anal fistula,this mechanism still needs to be further verified in cryptoglandular anal fistula.This mechanism suggests that in the future,we can participate in the prevention and treatment of anal fistula by regulating the intestinal flora of patients,reducing inflammation and in-tervening in the process of EMT,in order to provide a new way of non-surgical treatment for anal fistula and reduce the pain of diagnosis and treatment of patients.
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