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Review
. 2021 Jun;56(6):489-526.
doi: 10.1007/s00535-021-01784-1. Epub 2021 Apr 22.

Evidence-based clinical practice guidelines for inflammatory bowel disease 2020

Hiroshi Nakase  1   2 , Motoi Uchino  3 , Shinichiro Shinzaki  3 , Minoru Matsuura  3 , Katsuyoshi Matsuoka  3 , Taku Kobayashi  3 , Masayuki Saruta  3 , Fumihito Hirai  3 , Keisuke Hata  3 , Sakiko Hiraoka  3 , Motohiro Esaki  3 , Ken Sugimoto  3 , Toshimitsu Fuji  3 , Kenji Watanabe  3 , Shiro Nakamura  3 , Nagamu Inoue  3 , Toshiyuki Itoh  3 , Makoto Naganuma  3 , Tadakazu Hisamatsu  3 , Mamoru Watanabe  3 , Hiroto Miwa  3 , Nobuyuki Enomoto  3 , Tooru Shimosegawa  3 , Kazuhiko Koike  3
Affiliations
Review

Evidence-based clinical practice guidelines for inflammatory bowel disease 2020

Hiroshi Nakase et al. J Gastroenterol. 2021 Jun.

Abstract

Inflammatory bowel disease (IBD) is a general term for chronic or remitting/relapsing inflammatory diseases of the intestinal tract and generally refers to ulcerative colitis (UC) and Crohn's disease (CD). Since 1950, the number of patients with IBD in Japan has been increasing. The etiology of IBD remains unclear; however, recent research data indicate that the pathophysiology of IBD involves abnormalities in disease susceptibility genes, environmental factors and intestinal bacteria. The elucidation of the mechanism of IBD has facilitated therapeutic development. UC and CD display heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management depends on the understanding and tailoring of evidence-based interventions by physicians. In 2020, seventeen IBD experts of the Japanese Society of Gastroenterology revised the previous guidelines for IBD management published in 2016. This English version was produced and modified based on the existing updated guidelines in Japanese. The Clinical Questions (CQs) of the previous guidelines were completely revised and categorized as follows: Background Questions (BQs), CQs, and Future Research Questions (FRQs). The guideline was composed of a total of 69 questions: 39 BQs, 15 CQs, and 15 FRQs. The overall quality of the evidence for each CQ was determined by assessing it with reference to the Grading of Recommendations Assessment, Development and Evaluation approach, and the strength of the recommendation was determined by the Delphi consensus process. Comprehensive up-to-date guidance for on-site physicians is provided regarding indications for proceeding with the diagnosis and treatment.

Keywords: Biologics; Immunomodulators; Inflammatory bowel disease; Steroid.

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Conflict of interest statement

Any financial relationship with enterprises, businesses or academic institutions in the subject matter or materials discussed in the manuscript are listed as follows; (1) those from which the authors, the spouse, partner or immediate relatives of authors, have received individually any income, honoraria or any other types of remuneration; Abbvie, Kissei Pharmaceutical, Kyorin Pharmaceutical, Mitsubishi Tanabe Pharma, Janssen Pharmaceutical, Takeda Pharmaceutical, Pfizer, Celgene, EA Pharma, Zeria Pharmaceutical, Mochida Pharmaceutical, Nippon Kayaku, Daiichi Sankyo, JIMRO, Alfressa Pharma, Gilead Sciences, and (2) those from which the authors have received scholarship/research grant; Nippon Kayaku, Takeda Pharmaceutical, Otsuka Pharmaceutical, Eisai, EA Pharma, Hoya Group Pentax Medical, Abbvie, Mitsubishi Tanabe Pharma, Mochida Pharmaceutical, Janssen Pharmaceutical, EA Pharma, JIMRO, Zeria Pharmaceutical, Pfizer, Alfressa Pharma, Boehringer Ingelheim, Celgene, Eli Lilly and Company, Gilead Sciences, Kissei Pharmaceutical, and (3) those from which the authors have received individually endowed chair; Mitsubishi Tanabe Pharma, EA Pharma, AbbVie, Janssen Pharmaceutical, Mochida Pharmaceutical, Takeda Pharmaceutical, Kyorin Holdings, JIMRO, Zeria Pharmaceutical, Otsuka Pharmaceutical.

Figures

Fig. 1
Fig. 1
Diagnostic approach for ulcerative colitis. Mild to moderate active left-sided colitis type (not extending beyond the sigmoid colon) and proctitis type
Fig. 2
Fig. 2
Diagnostic approach to Crohn's disease
Fig. 3
Fig. 3
Remission induction therapy for ulcerative colitis
Fig. 4
Fig. 4
Mild to moderate active-stage total colitis type, right-sided or regional colitis type remission induction therapy for left-sided colitis type (beyond sigmoid colon) ulcerative colitis
Fig. 5
Fig. 5
Treatment for severe ulcerative colitis
Fig. 6
Fig. 6
Treatment of refractory cases of ulcerative colitis (including maintenance therapy)
Fig. 7
Fig. 7
Induction of remission for active Crohn's disease
Fig. 8
Fig. 8
Treatment of gastrointestinal complications of Crohn's disease
Fig. 9
Fig. 9
Maintenance therapy for Crohn's disease in remission
See this image and copyright information in PMC

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