Intest Res.  2023 Jul;21(3):353-362. 10.5217/ir.2023.00013.

Infectious complications in patients with inflammatory bowel disease in Asia: the results of a multinational web-based survey in the 8th Asian Organization for Crohn’s and Colitis meeting

• Jun YK
• Koh SJ
• Myung DS
• Park SH
• Ooi CJ
• Sood A
• Im JP

• KMID: 2544758
• DOI: http://doi.org/10.5217/ir.2023.00013

Abstract

Background/Aims
Infectious complications are major concerns when treating patients with inflammatory bowel disease (IBD). This study evaluated clinical differences across countries/regions in the management of infectious diseases in patients with IBD.
Methods
A multinational online questionnaire survey was administered to participants at the 8th meeting of the Asian Organization for Crohn’s and Colitis. The questionnaire included questions regarding surveillance, diagnosis, management, and prevention of infection in patients with IBD.
Results
A total of 384 physicians responded to the questionnaire. The majority of Korean (n=70, 63.6%) and Chinese (n=51, 51.5%) physicians preferred vancomycin to metronidazole in the treatment of Clostridium difficile infection, whereas more than half of the Japanese physicians (n=62, 66.7%) preferred metronidazole. Physicians in Korea (n=88, 80.0%) and China (n=46, 46.5%) preferred a 3-month course of isoniazid and rifampin to treat latent tuberculosis infection, whereas most physicians in Japan (n=71, 76.3%) favored a 9-month course of isoniazid. Most Korean physicians (n=89, 80.9%) recommended hepatitis B virus (HBV) vaccination in patients lacking HBV surface antigen, whereas more than half of Japanese physicians (n=53, 57.0%) did not consider vaccination.
Conclusions
Differences in the diagnosis, prevention, and management of infections in patients with IBD across countries/regions reflect different prevalence rates of infectious diseases. This survey may broaden understanding of the real-world clinical settings across Asian countries/regions and provide information for establishing practical guidelines to manage patients with IBD.

Keyword

Inflammatory bowel diseases; Cytomegalovirus; infection; Tuberculosis; Chronic viral hepatitis

Figure

• 

  Fig. 1. Management of cytomegalovirus (CMV) infection in patients with inflammatory bowel disease (IBD). (A) The clinical circumstances when physicians suspected CMV colitis. (B) The methods for diagnosis of CMV colitis. (C) Differences among physicians from various countries in their management of CMV colitis. Subtle differences were observed among countries/regions in the preferred antiviral agents used to treat CMV infection. H&E, hematoxylin and eosin; Ig, immunoglobulin; IV, intravenous; PO, by mouth.

• 

  Fig. 2. Diagnosis and treatment of Clostridium difficile infection (CDI) in patients with inflammatory bowel disease (IBD). (A) Rates of evaluation by Asian physicians of CDI in patients with IBD. Most physicians reported assessing CDI in all patients with active stage IBD. (B) Rates of diagnostic assays for CDI showing that the stool C. difficile toxin A/B test was the most widely used. (C) Rates of agents used in various Asian countries to treat CDI in IBD patients. Physicians from Korea and China preferred vancomycin is preferred over metronidazole, whereas physicians from Japan preferred metronidazole. PCR, polymerase chain reaction; GDH, glutamate dehydrogenase.

• 

  Fig. 3. Diagnosis and treatment of tuberculosis (TB) in patients with inflammatory bowel disease (IBD). (A) Rates of evaluation by Asian physicians of active or latent TB in patients with IBD. Most physicians reported assessing TB before initiating treatment with biologics or small molecules. (B) Methods preferred by Asian physicians for the assessment of latent TB infection (LTBI). Interferon-γ release assay was the most preferred method, followed by chest radiography. (C) Regimens preferred by Asian physicians for the treatment of LTBI showed that the combination of isoniazid and rifampin for 3 months was the most frequently used regimen. IGRA, interferon-γ release assay; PPD, purified protein derivative.

• 

  Fig. 4. Management of chronic hepatitis B (CHB) and prevention of hepatitis B virus (HBV) reactivation in patients with inflammatory bowel disease (IBD). (A) Rates of HBV screening by Asian physicians of patients with IBD. (B) CHB diagnostic tests in patients positive for HBV core antibody. (C) Differences among physicians from various countries in their management of HBV surface antigen (HBsAg)-negative patients. Unlike Japanese physicians, Korean and Chinese physicians tended to vaccinate IBD patients for HBV. (D) Rates of antiviral treatment before initiation of biologics in patients with positive HBsAg. (E) Rates of antiviral treatment before initiation of immunosuppressants in patients with positive HBsAg.

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