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

• Wei SC
• Chang TA
• Chao TH
• Chen JS
• Chou JW
• Chou YH
• Chuang CH
• Hsu WH
• Huang TY
• Hsu TC
• Lin CC
• Lin HH
• Lin JK
• Lin WC
• Ni YH
• Shieh MJ
• Shih IL
• Shun CT
• Tsang YM
• Wang CY
• Wang HY
• Weng MT
• Wu DC
• Wu WC
• Yen HH
• Wong JM

• 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.

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