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

doi:10.5217/ir.2017.15.3.285

Review

. 2017 Jul;15(3):285-310.

doi: 10.5217/ir.2017.15.3.285. Epub 2017 Jun 12.

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

Shu-Chen Wei¹, Ting-An Chang², Te-Hsin Chao³, Jinn-Shiun Chen⁴, Jen-Wei Chou⁵, Yenn-Hwei Chou⁶, Chiao-Hsiung Chuang⁷, Wen-Hung Hsu⁸, Tien-Yu Huang⁹, Tzu-Chi Hsu¹⁰, Chun-Chi Lin¹¹, Hung-Hsin Lin^{11

12}, Jen-Kou Lin¹¹, Wei-Chen Lin¹³, Yen-Hsuan Ni¹⁴, Ming-Jium Shieh¹⁵, I-Lun Shih¹⁶, Chia-Tung Shun¹⁷, Yuk-Ming Tsang¹⁸, Cheng-Yi Wang¹, Horng-Yuan Wang^{19

20

21}, Meng-Tzu Weng²², Deng-Chyang Wu^{23

24}, Wen-Chieh Wu²⁵, Hsu-Heng Yen²⁶, Jau-Min Wong¹

Affiliations

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

PMID: 28670226
PMCID: PMC5478754
DOI: 10.5217/ir.2017.15.3.285

Review

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

Shu-Chen Wei et al. Intest Res. 2017 Jul.

. 2017 Jul;15(3):285-310.

doi: 10.5217/ir.2017.15.3.285. Epub 2017 Jun 12.

Authors

Affiliations

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

PMID: 28670226
PMCID: PMC5478754
DOI: 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.

Keywords: Consensus statements; Crohn disease; Disease management; Inflammatory bowel diseases; Taiwan.

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Conflict of interest statement

Conflict of interest: None.

Figures

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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References

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[1] Torres J, Mehandru S, Colombel JF, Peyrin-Biroulet L. Crohn's disease. Lancet. 2017;389:1741–1755. - PubMed

[2] Torres J, Mehandru S, Colombel JF, Peyrin-Biroulet L. Crohn's disease. Lancet. 2017;389:1741–1755. - PubMed

[3] Loftus EV., Jr Crohn's disease: why the disparity in mortality? Gut. 2006;55:447–449. - PMC - PubMed

[4] Loftus EV., Jr Crohn's disease: why the disparity in mortality? Gut. 2006;55:447–449. - PMC - PubMed

[5] Selinger CP, Leong RW. Mortality from inflammatory bowel diseases. Inflamm Bowel Dis. 2012;18:1566–1572. - PubMed

[6] Selinger CP, Leong RW. Mortality from inflammatory bowel diseases. Inflamm Bowel Dis. 2012;18:1566–1572. - PubMed

[7] Wei SC, Lin MH, Tung CC, et al. A nationwide populationbased study of the inflammatory bowel diseases between 1998 and 2008 in Taiwan. BMC Gastroenterol. 2013;13:166. - PMC - PubMed

[8] Wei SC, Lin MH, Tung CC, et al. A nationwide populationbased study of the inflammatory bowel diseases between 1998 and 2008 in Taiwan. BMC Gastroenterol. 2013;13:166. - PMC - PubMed

[9] Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142:46–54. - PubMed

[10] Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142:46–54. - PubMed

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

Affiliations

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

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