Management consensus of inflammatory bowel disease for the Asia–Pacific region

Abstract

At the present there are no large-scale epidemiologic data on inflammatory bowel disease (IBD) in the Asia-Pacific region, but several studies have shown an increased incidence and prevalence of IBD in this region. Compared to the West, there appears to exist a time lag phenomenon. With regard to the two main forms of IBD, ulcerative colitis (UC) is more prevalent than Crohn's disease (CD). In addition to geographic differences, ethnic differences have been observed in the multiracial Asian countries. Moreover, the genetic backgrounds are different in the Asian compared to Western patients. For instance, NOD2/CARD15 variants have not been found in Asian CD patients. In general, the clinical course of IBD seems to be less severe in the Asia-Pacific region than in Western countries. Diagnosis of IBD in this region poses special problems. The lack of a gold standard for the diagnosis of IBD, and the existence of a variety of infectious enterocolitis with similar manifestations to those of IBD make the differential diagnosis particularly difficult. So far, Western diagnostic criteria have been introduced for the diagnosis of IBD. A stepwise approach to exclude non-IBD enterocolitis also must be introduced, and a definite diagnosis must include typical histological features. In some patients, follow up and therapeutic trials might be necessary to obtain a definitive diagnosis. A better understanding of the pathogenesis of IBD will allow the development of better diagnostic markers. The management of IBD also poses some special problems in the Asia-Pacific Region. There is often a delay in using proper medications for IBD, and alternative local remedies are still widely used. With a combination of Western guidelines and regional experiences, similar principles can be used for induction and maintenance of remission. A stepwise selection of medications is advocated depending on the extent, activity and severity of the disease. Comprehensive and individualized approaches are suggested for different IBD patients. Deeper understanding of disease pathogenesis and the unique characteristics of IBD in the Asia-Pacific region, combined with reasonable and practical guidelines for drug management and the future use of biological agents would improve the therapeutic outlook of IBD in this region.

Clinical value of fecal calprotectin in determining disease activity of ulcerative colitis

“…It reflects the clinical representation of UC and is the most extensive and simplest DAI. It is adopted by the guidelines for the management of infl ammatory bowel disease in the fourth Asia Pacific Digestive Week [28] . Our results showed that fecal calprotectin concentrations were signifi cantly higher in the patients with active UC than in the patients with inactive UC and in the controls.…”

Seasonality in Flares and Months of Births of Patients with Ulcerative Colitis in a Chinese Population

“…Almost all of the UC patients came from the Westeast Lake District and Nanchang County of Nanchang City, and Yicheng County of Yicheng City. The diagnosis of UC had been established by clinical, endoscopic, histological, and/ or radiological criteria [16]. Endoscopy was performed in most of the patients and revealed typical signs of UC.…”

Targeted Inhibition of Serotonin Type 7 (5-HT7) Receptor Function Modulates Immune Responses and Reduces the Severity of Intestinal Inflammation

“…The incidence and prevalence of human bowel diseases such as IBD have shown a dramatic increase in the last decades (11,12). Although the exact cause of IBD is unknown, studies have provided evidence that a dysregulated immune response, genetic factors, enteric flora, and environmental factors contribute to the pathogenesis of IBD (13)(14)(15)(16).…”