Intest Res.  2023 Jul;21(3):328-338. 10.5217/ir.2023.00012.

Diagnosis of inflammatory bowel disease–Asian perspectives: the results of a multinational web-based survey in the 8th Asian Organization for Crohn’s and Colitis meeting

• Lee HH
• Park JJ
• Lee BI
• Hilmi I
• Sollano J
• Ran ZH

• KMID: 2544756
• DOI: http://doi.org/10.5217/ir.2023.00012

Abstract

Background/Aims
Inflammatory bowel disease (IBD) is no longer a rare disease in Asia, thus it needs to prepare recommendations relevant to Asian patients. This study aimed to identify disparities in the process of the diagnosis of IBD in Asian countries/regions.
Methods
In line with the 2020 Asian Organization for Crohn’s and Colitis annual meeting, a multinational web-based survey about Asian physicians’ perspectives on IBD was conducted.
Results
A total of 384 Asian physicians (99 in China, 93 in Japan, 110 in Korea, and 82 in other Asian countries/regions) treating IBD patients from 24 countries/regions responded to the survey. Most respondents were gastroenterologists working in an academic teaching hospital. About half of them had more than 10 years of clinical experience in caring for patients with IBD. The European Crohn’s Colitis Organisation guideline was used most commonly for the diagnosis of IBD except for Japanese physicians who preferred their own national guideline. The Mayo score and Crohn’s Disease Activity Index were the most commonly used activity scoring systems for ulcerative colitis and Crohn’s disease, respectively. Endoscopy, not surprisingly, was the main investigation in assessing the extent and activity of IBD. On the other hand, there were disparities across countries/regions with regard to the favored modalities of small bowel and perianal evaluation of Crohn’s disease, as well as the use of serologic markers.
Conclusions
Results of the present survey revealed practical behaviors of Asian physicians in the diagnosis of IBD. Investigating the reasons for different diagnostic approaches among countries/regions might help us develop Asian guidelines further.

Keyword

Inflammatory bowel disease; Diagnosis; Survey; Asia

Figure

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  Fig. 1. Diagnostic guidelines and the Montreal classification. (A) The most commonly used guidelines for the diagnosis of inflammatory bowel disease (IBD). (B) Use of the Montreal classification for classifying disease extent of ulcerative colitis (UC) at the time of diagnosis. (C) Use of the Montreal classification for classifying Crohn’s disease (CD) at the time of diagnosis.

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  Fig. 2. Clinical assessments. (A) Clinical scoring systems for ulcerative colitis. (B) Clinical scoring systems for Crohn’s disease. (C) Use of fecal calprotectin.

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  Fig. 3. Endoscopic assessments. (A) Endoscopic scoring system for ulcerative colitis (UC). (B) Terminal ileum intubation during colonoscopy for Crohn’s disease (CD). (C) Esophagogastroduodenoscopy (EGD) for CD.

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  Fig. 4. Radiologic assessments. (A) Preferred modalities for small bowel imaging for Crohn’s disease (CD). (B) Preferred modalities for evaluation of perianal disease for CD. CT, computed tomography; MR, magnetic resonance; MRI, magnetic resonance imaging.

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  Fig. 5. Serologic assessments and exclusion of infectious diseases. (A) Anti-neutrophil cytoplasmic antibody (ANCA) and/or anti-Saccharomyces cerevisiae antibody (ASCA) for ulcerative colitis (UC). (B) ASCA and/or ANCA for Crohn’s disease (CD). (C) Microbiological culture for suspected UC. (D) Clostridium difficile test for suspected UC.

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