A Questionnaire-Based Survey on the Diagnosis and Management of Inflammatory Bowel Disease in East Asian Countries in 2012

Abstract

Background and Aim: The prevalence and incidence of inflammatory bowel disease (IBD) are lower in East Asia than in Western countries; however, marked increases have recently been reported. The clinical diagnosis and medical management of IBD in East Asia differ from those in Western countries. A questionnaire-based survey was performed to gather physicians' current opinions on IBD in different East Asian countries. Methods: Representative International Gastrointestinal Consensus Symposium (IGICS) committee members provided a questionnaire to physicians in each East Asian country studied. The questionnaire mainly focused on the diagnosis and management of IBD. Results: There were 19 respondents from Japan, 10 from South Korea, 9 from the Philippines, 6 from China and 4 from Indonesia. Colonoscopy (100%) and histopathology (63%) were commonly used for the diagnosis in ulcerative colitis (UC). Conventional small bowel enteroclysis was still the most common diagnostic tool for assessing small bowel lesions in Crohn's disease (CD) in East Asia. The percentage of physicians who investigated the reactivation of Cytomegalovirus in severe or refractory patients with UC ranged from 0% in the Philippines and Indonesia to 100% in Japan and Korea. Most physicians in Korea, the Philippines, China and Indonesia chose thiopurines or anti-TNF therapy as the second-line treatment in severe refractory UC, whereas Japanese physicians preferred to use tacrolimus or leukocyte apheresis. Physicians in the Philippines and Indonesia preferred to use oral 5-aminosalicylic acid for newly diagnosed severe ileocecal CD. In contrast, Korean physicians chose oral steroids and most physicians in China and Japan preferred to use anti-TNF. Nutritional therapy to induce or maintain remission in patients with CD was commonly used in Indonesia, Japan and China. Targeted biopsies by conventional colonoscopy were the most preferred strategy for cancer surveillance in long-standing UC over random biopsies in this region. Conclusions: The present survey found that current diagnostic approaches and clinical management of IBD vary within East Asian countries.

The Same Intestinal Inflammatory Disease despite Different Genetic Risk Factors in the East and West?

“…In Japan, tacrolimus [39,40] and leukocyte apheresis [41] are also widely used as second-line treatment in severe refractory UC [42]. …”

Treatment of Active Crohn’s Disease with Exclusive and Partial Enteral Nutrition: A Pilot Study in Adults

“…Nutrition-based treatments, the most common being exclusive enteral nutrition (EEN), is recommended as a first-line therapy to treat active paediatric CD [5]. EEN is now commonly used to treat active CD in children and adolescents in New Zealand (NZ) [6], Australia [7], Asia [8], Canada [9] and Europe [10]. Adults with CD are interested in nutrition-based alternatives to corticosteroids [11], and EEN is regularly used in Japan [12], and increasingly in China [13] to treat adults with active CD.…”

Efficacy and Safety of Oral Budesonide in Patients with Active Crohn's Disease in Japan: A Multicenter, Double-Blind, Randomized, Parallel-Group Phase 3 Study

“…About half of the patients in the present study were concomitantly using nutritional therapy or immunosuppressants. Use of several therapies in parallel reflects common practice in Japan, where nutritional therapy and immunomodulators are often used to support induction or maintenance therapy in patients with CD [3,20]. A specialized "elemental diet" as nutritional therapy has been shown to be safe for patients with CD [14], and is widely used in Japan for the treatment of mild-to-moderate CD in combination with ethyl cellulose-coated mesalazine 3 g per day.…”