Diagnosis of inflammatory bowel disease in Asia: the results of a multinational web-based survey in the 2(nd) Asian Organization for Crohn's and Colitis (AOCC) meeting in Seoul

Abstract

Background/aims: As the number of Asian patients with inflammatory bowel disease (IBD) has increased recently, there is a growing need to improve IBD care in this region. This study is aimed at determining how Asian countries are currently dealing with their IBD patients in terms of diagnosis.

Methods: A questionnaire was designed by the organizing committee of Asian Organization for Crohn's and Colitis, for a multinational web-based survey conducted between March 2014 and May 2014.

Results: A total of 353 Asian medical doctors treating IBD patients responded to the survey (114 in China, 88 in Japan, 116 in Korea, and 35 in other Asian countries). Most of the respondents were gastroenterologists working in an academic teaching hospital. While most of the doctors from China, Japan, and Korea use their own national guidelines for IBD diagnosis, those from other Asian countries most commonly adopt the European Crohn's Colitis Organisation's guideline. Japanese doctors seldom adopt the Montreal classification for IBD. The most commonly used activity scoring system for ulcerative colitis is the Mayo score in all countries except China, whereas that for Crohn's disease (CD) is the Crohn's Disease Activity Index. The most available tool for small-bowel evaluation in CD patients differs across countries. Many physicians administer empirical anti-tuberculous medications before the diagnosis of CD.

Conclusions: The results of this survey demonstrate that Asian medical doctors have different diagnostic approaches for IBD. This knowledge would be important in establishing guidelines for improving the care of IBD patients in this region.

Keywords: Asia; Diagnosis; Inflammatory bowel diseases; Survey.

Fig. 1. Diagnostic guidelines and the Montreal classification. (A) Proportion of physicians from each country who use IBD diagnostic guidelines. (B) Proportion of physicians from each country who adopt the Montreal classification. ECCO, European Crohn's and Colitis Organisation; AGA, American Gastroenterological Association; BSG, British Society of Gastroenterology.

Fig. 2. Clinical, endoscopic, and radiologic assessment tools. (A) Clinical severity scoring systems for IBD. (B) Proportion of physicians from each country who use endoscopy to document the activity and extent of disease. (C) Proportion of physicians from each country who use a classification system for the endoscopic severity of UC, such as the Mayo endoscopic subscore. (D) First-line modalities for small-bowel evaluation in suspected CD. HBI, Harvey–Bradshaw Index; PCDAI, Pediatric Crohn's Disease Activity Index; IOIBD, International Organization for the Study of IBD; UCDAI, UC Disease Activity Index; SBFT, small bowel follow-through; USG, ultrasonography; CTE, CT enterography; MRE, magnetic resonance enterography; BAE, balloon-assisted enteroscopy; CE, capsule endoscopy.

Fig. 3. Evaluations for excluding infectious diseases. (A) Proportion of physicians from each country who perform microbiological cultures for suspected UC. (B) Proportion of physicians from each country who conduct stool Clostridium difficile toxin assay for suspected UC. (C) Proportion of physicians from each country according to percentage of their CD patients with empirical anti-tuberculous medications before the diagnosis of CD.