Management of Crohn's disease in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

Wei, Shu Chen; Chang, Ting An; Chao, Te Hsin; Chen, Jinn Shiun; Chou, Jen Wei; Chou, Yenn Hwei; Chuang, Chiao Hsiung; Hsu, Wen Hung; Huang, Tien Yu; Hsu, Tzu Chi; Lin, Chun Chi; Lin, Hung Hsin; Lin, Jen Kou; Lin, Wei Chen; Ni, Yen Hsuan; Shieh, Ming Jium; Shih, I Lun; Shun, Chia Tung; Tsang, Yuk Ming; Wang, Cheng Yi; Wang, Horng Yuan; Weng, Meng Tzu; Wu, Deng Chyang; Wu, Wen Chieh; Yen, Hsu Heng; Wong, Jau Min

Intest Res. 2017 Jul;15(3):285-310. 10.5217/ir.2017.15.3.285.

Management of Crohn's disease in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

Affiliations

¹Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. jmwong@ntu.edu.tw
²Department of Pathology, Taipei City Hospital Renai Branch, Taipei, Taiwan.
³Division of Colorectal Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
⁴Division of Colorectal Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
⁵Division of Gastroenterology and Hepatology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
⁶Division of General Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
⁷Department of Internal Medicine, National Cheng Kung University Hospital, National Cheng Kung University College of Medicine, Tainan, Taiwan.
⁸Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Municipal Hsiaokang Hospital, Kaohsiung, Taiwan.
⁹Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
¹⁰Division of Colon and Rectal Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan.
¹¹Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
¹²Department of Surgery, National Yang-Ming University, Taipei, Taiwan.
¹³Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
¹⁴Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
¹⁵Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
¹⁶Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
¹⁷Department of Pathology and Forensic Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
¹⁸Division of Medical Imaging, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
¹⁹Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
²⁰MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.
²¹MacKay Medical College, New Taipei City, Taiwan.
²²Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
²³Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
²⁴Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
²⁵Division of Gastroenterology, Department of Medicine, Taipei City Hospital Renai Branch, Taipei, Taiwan.
²⁶Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.

KMID: 2382373
DOI: http://doi.org/10.5217/ir.2017.15.3.285

Abstract

Crohn's disease (CD) is a chronic relapsing and remitting inflammatory disease of the gastrointestinal tract. CD is rare in Taiwan and other Asian countries, but its prevalence and incidence have been steadily increasing. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of CD taking into account currently available evidence and the expert opinion of the committee. Thorough clinical, endoscopic, and histological assessments are required for accurate diagnosis of CD. Computed tomography and magnetic resonance imaging are complementary to endoscopic evaluation for disease staging and detecting complications. The goals of CD management are to induce and maintain remission, reduce the risk of complications, and improve quality of life. Corticosteroids are the mainstay for inducing re-mission. Immunomodulating and biologic therapies should be used to maintain remission. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to treatment and receive regular surveillance for cancer. These consensus statements are based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of patients with CD in Taiwan.

Keyword

Taiwan; Crohn disease; Inflammatory bowel diseases; Disease management; Consensus statements

MeSH Terms

Adrenal Cortex Hormones
Asian Continental Ancestry Group
Biological Therapy
Consensus*
Crohn Disease*
Diagnosis
Disease Management
Expert Testimony
Gastrointestinal Tract
Hepatitis B virus
Humans
Incidence
Inflammatory Bowel Diseases*
Magnetic Resonance Imaging
Prevalence
Quality of Life
Taiwan*
Tuberculosis
Adrenal Cortex Hormones

Figure

Fig. 1 Recommended checklist for use during histological assessment of IBD. Use of this checklist during histological assessment is recommended to support thorough evaluation of mucosal architecture and inflammatory infiltrates and exclusion of differential diagnoses (disease activity scoring using the Nancy histological index is suggested only for patients with UC). TB, tuberculosis; CMV, cytomegalovirus.
Fig. 2 Recommended algorithm for the treatment of CD. Treatment algorithm for patients with CD developed through consensus of an expert panel established by the Taiwan Society of Inflammatory Bowel Disease. Recommendations were formulated after consideration of available evidence and expert opinion as well as the medical environment specific to Taiwan. Immunomodulators include methotrexate (MTX) and thiopurines (azathioprine [AZA] and 6-mercaptopurine [6-MP]). IV steroid treatment consists of methylprednisolone 60 mg/day or hydrocortisone 100 mg 4 times daily. Biologics include infliximab, adalimumab, golimumab, and vedolizumab among others. aMTX maintenance dosage: 10–15 mg/wk. 5-ASA, 5-aminosalicylic acid (mesalamine); IV, intravenous; CMV, cytomegalovirus; IM, intramuscular; TFDA, Taiwan Food and Drug Administration.

Cited by 4 articles

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Management of Crohn’s disease in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease updated in 2023
Jia-Feng Wu, Hsu-Heng Yen, Horng-Yuan Wang, Ting-An Chang, Chung-Hsin Chang, Chen-Wang Chang, Te-Hsin Chao, Jen-Wei Chou, Yenn-Hwei Chou, Chiao-Hsiung Chuang, Wen-Hung Hsu, Tzu-Chi Hsu, Tien-Yu Huang, Tsung-I Hung, Puo-Hsien Le, Chun-Che Lin, Chun-Chi Lin, Ching-Pin Lin, Jen-Kou Lin, Wei-Chen Lin, Yen-Hsuan Ni, Ming-Jium Shieh, I-Lun Shih, Chia-Tung Shun, Tzung-Jiun Tsai, Cheng-Yi Wang, Meng-Tzu Weng, Jau-Min Wong, Deng-Chyang Wu, Shu-Chen Wei
Intest Res. 2024;22(3):250-285. doi: 10.5217/ir.2024.00060.

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Management of Crohn's disease in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

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