Intestinal Research

Review

IBD

Optimizing 5-aminosalicylate for moderate ulcerative colitis: expert recommendations from the Asia-Pacific, Middle East, and Africa Inflammatory Bowel Disease Coalition: Filiz Akyüz, Yoon Kyo An, Jakob Begun, Satimai Aniwan, Huu Hoang Bui, Webber Chan, Chang Hwan Choi, Nazeer Chopdat, Susan J Connor, Devendra Desai, Emma Flanagan, Taku Kobayashi, Allen Yu-Hung Lai, Rupert W Leong, Alex Hwong-Ruey Leow, Wai Keung Leung, Julajak Limsrivilai, Virly Nanda Muzellina, Kiran Peddi, Zhihua Ran, Shu Chen Wei, Jose Sollano, Michelle Mui Hian Teo, Kaichun Wu, Byong Duk Ye, Choon Jin Ooi; Intest Res 2025;23(1):37-55. Published online November 4, 2024; DOI: https://doi.org/10.5217/ir.2024.00089

The lack of clear definition and classification for “moderate ulcerative colitis (UC)” creates ambiguity regarding the suitability of step-up versus top-down treatment approaches. In this paper, experts address crucial gaps in assessing and managing moderate UC. The Asia-Pacific, Middle East, and Africa Inflammatory Bowel Disease Coalition comprised 24 experts who convened to share, discuss and vote electronically on management recommendations for moderate UC. Experts emphasized that the goal of treating UC is to attain clinical, biomarker, and endoscopic remission using cost-effective strategies such as 5-aminosalicylates (5-ASAs), well-tolerated therapy that can be optimized to improve outcomes. Experts agreed that 5-ASA therapy could be optimized by maximizing dosage (4 g/day for induction of remission), combining oral and topical administration, extending treatment duration beyond 8 weeks, and enhancing patient adherence through personalized counselling and reduced pill burden. Treatment escalation should ideally be reserved for patients with predictors of aggressive disease or those who do not respond to 5-ASA optimization. Premature treatment escalation to advanced therapies (including biologics and oral small molecules) may have long-term health and financial consequences. This paper provides consensus-based expert recommendations and a treatment algorithm, based on current evidence and practices, to assist decision-making in real-world settings.

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Inflammatory bowel disease in Africa: the current landscape of pharmacological treatments and the promise of emerging innovations
Murtada A. Oshi
Exploration of Drug Science.2025;[Epub] CrossRef

19,479 View
378 Download
1 Web of Science
1 Crossref

Original Articles

IBD

Drug therapy and monitoring for inflammatory bowel disease: a multinational questionnaire investigation in Asia: Chenwen Cai, Juntao Lu, Lijie Lai, Dongjuan Song, Jun Shen, Jinlu Tong, Qing Zheng, Kaichun Wu, Jiaming Qian, Zhihua Ran; Intest Res 2022;20(2):213-223. Published online April 29, 2022; DOI: https://doi.org/10.5217/ir.2021.00031

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
The incidence and prevalence of inflammatory bowel disease (IBD) is rising in Asia recently. The study aimed to obtain a comprehensive understanding of the current status of drug therapy and monitoring for IBD in Asia.
Methods
A questionnaire investigation on drug therapy and monitoring for IBD was conducted right before the 6th Annual Meeting of Asian Organization for Crohn’s & Colitis. Questionnaires were provided to Asian physicians to fill out via emails between March and May 2018.
Results
In total, responses of 166 physicians from 129 medical centers were included for analysis. Among the surveyed regions, the most average number of IBD specialist gastroenterologists and nurses was 4.8 per center in Taiwan and 2.5 per center in Mainland China, respectively. 5-Aminosalicylic acid/sulfasalazine (99.4%) was the most preferred first-line choice for mild-moderate ulcerative colitis (UC), meanwhile corticosteroid (83.7%) was widely applied for severe UC. The first-line medication for Crohn’s disease (CD) markedly varied as corticosteroid (68.1%) was the most favored in Mainland China, Japan, and South Korea, followed by infliximab (52.4%) and azathioprine (47.0%). Step-up strategy was preferred in mild-moderate UC (96.4%), while 51.8% of the physicians selected top-down treatment for CD. Only 25.9% and 17.5% of the physicians could test blood concentration of infliximab and antibody to infliximab in their hospitals, respectively.
Conclusions
The current status of drug therapy and monitoring for IBD in Asia possesses commonalities as well as differences. Asian recommendations, IBD specialist teams and practice of therapeutic drug monitoring are required to improve IBD management in Asia.

Citations

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Expression and role of CTHRC1 in inflammatory bowel disease in children
Heng Tang, Xiang Gao, Zhaofang Wu, Jia Chen, Li Chen, Xiang Du
Cytotechnology.2025;[Epub] CrossRef
Importance of STAT3 signaling in preeclampsia (Review)
Daniela Marzioni, Federica Piani, Nicoletta Di Simone, Stefano Giannubilo, Andrea Ciavattini, Giovanni Tossetta
International Journal of Molecular Medicine.2025;[Epub] CrossRef
Optimizing Infliximab Use in Real-World Inflammatory Bowel Disease: Insights from a Population Pharmacokinetic Model Integrating Intravenous and Subcutaneous Formulations
Sung Hoon Jung, Sang-Bum Kang
Gut and Liver.2025; 19(3): 299. CrossRef
New genetic biomarkers predicting 5-aminosalicylate-induced adverse events in patients with inflammatory bowel diseases
Jihye Park, I. Seul Park, Ji Hyung Kim, Jung Hyun Ji, Soo Jung Park, Jae Jun Park, Tae Il Kim, Seung Won Kim, Jae Hee Cheon
Therapeutic Advances in Gastroenterology.2024;[Epub] CrossRef
Primary surgery versus pharmacotherapy for newly diagnosed ileocecal Crohn’s disease: a hospital-based cohort study
Yehyun Park, Soo Jung Park, Tae Il Kim, Won Ho Kim, Jae Hee Cheon
The Korean Journal of Internal Medicine.2024; 39(5): 759. CrossRef
Signal detection and analysis of sulfasalazine adverse reaction events based on the US FDA adverse event reporting database
Yikuan Du, Lingzhi Zhang, Liang Shi, Zhuoming Guo, Ziyi Luo, Ye Zheng, Yu Zeng, Yin Huang, Jiawen Luo, Xiaochun Guo, Mianda Hu, Yuhong Chen, Jinfeng Zhu, Yi Liu, Chun Yang
Expert Opinion on Drug Safety.2024; : 1. CrossRef
Impact of Concomitant 5-Aminosalicylic Acid Therapy on Vedolizumab Efficacy and Safety in Inflammatory Bowel Disease: Post Hoc Analyses of Clinical Trial Data
Ryan C Ungaro, Harisha Kadali, Wenwen Zhang, Shashi Adsul, Walter Reinisch
Journal of Crohn's and Colitis.2023; 17(12): 1949. CrossRef

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IBD

The association between new generation oral contraceptive pill and the development of inflammatory bowel diseases: Santosh Sanagapalli, Yanna Ko, Viraj Kariyawasam, Siew C Ng, Whitney Tang, Hithanadura Janaka de Silva, Minhu Chen, Kaichun Wu, Satimai Aniwan, Ka Kei Ng, David Ong, Qin Ouyang, Ida Hilmi, Marcellus Simadibrata, Pises Pisespongsa, Saranya Gopikrishna, Rupert W Leong; Intest Res 2018;16(3):409-415. Published online July 27, 2018; DOI: https://doi.org/10.5217/ir.2018.16.3.409

Abstract PDF PubReader ePub

<b>Background/Aims</b><br/>

To examine the association between use of oral contraceptive pills (OCPs) and the risk of developing inflammatory bowel diseases (IBD), in a modern cohort.

Methods

A prospective nested case-control study across sites in the Asia-Pacific region was conducted; involving female IBD cases and asymptomatic controls. Subjects completed a questionnaire addressing questions related to OCP use. Primary outcome was the risk of development of IBD of those exposed to OCP versus non-exposure. Secondary outcomes were development of Crohn's disease (CD) versus ulcerative colitis (UC), and whether age of first use of OCP use may be associated with risk of IBD.

Results

Three hundred and forty-eight female IBD cases (41% CD, median age: 43 years) and 590 female age-matched controls were recruited. No significant association was found between OCP use and the risk of IBD (odds ratio [OR], 1.65; 95% confidence interval, 0.77–3.13; P=0.22), CD (OR, 1.55) or UC (OR, 1.01). The lack of association persisted when results were adjusted for age and smoking. IBD cases commenced OCP use at a younger age than controls (18 years vs. 20 years, P=0.049).

Conclusions

In this large cohort of subjects from the Asia-Pacific region, we found a modest but not significantly increased risk of developing IBD amongst OCP users.

Citations

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Sex-related differences in profiles and clinical outcomes of Inflammatory bowel disease: a systematic review and meta-analysis
Dana A. Salem, Rawan El-Ijla, Razan R. AbuMusameh, Khaled A. Zakout, Alaa Y. Abu Halima, Mohammed T. Abudiab, Yahya M. Banat, Basel F. Alqeeq, Mohammed Al-Tawil, Khaled Matar
BMC Gastroenterology.2024;[Epub] CrossRef
Estrogen receptor actions in colitis
Erika L. Garcia-Villatoro, Clinton D. Allred
Essays in Biochemistry.2021; 65(6): 1003. CrossRef
Sex-based differences in inflammatory bowel diseases: a review
Sheila D. Rustgi, Maia Kayal, Shailja C. Shah
Therapeutic Advances in Gastroenterology.2020;[Epub] CrossRef

11,558 View
109 Download
4 Web of Science
3 Crossref

Special Review

IBD

Asian Organization for Crohn's and Colitis and Asia Pacific Association of Gastroenterology consensus on tuberculosis infection in patients with inflammatory bowel disease receiving anti-tumor necrosis factor treatment. Part 1: risk assessment: Dong Il Park, Tadakazu Hisamatsu, Minhu Chen, Siew Chien Ng, Choon Jin Ooi, Shu Chen Wei, Rupa Banerjee, Ida Normiha Hilmi, Yoon Tae Jeen, Dong Soo Han, Hyo Jong Kim, Zhihua Ran, Kaichun Wu, Jiaming Qian, Pin-Jin Hu, Katsuyoshi Matsuoka, Akira Andoh, Yasuo Suzuki, Kentaro Sugano, Mamoru Watanabe, Toshifumi Hibi, Amarender S. Puri, Suk-Kyun Yang; Intest Res 2018;16(1):4-16. Published online January 18, 2018; DOI: https://doi.org/10.5217/ir.2018.16.1.4

Abstract PDF PubReader ePub

Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from 9 Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 1 of the statements comprised 2 parts: risk of TB infection Recommendaduring anti-TNF therapy, and screening for TB infection prior to commencing anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.

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Soo-Young Na, Chang Hwan Choi, Eun Mi Song, Ki Bae Bang, Sang Hyoung Park, Eun Soo Kim, Jae Jun Park, Bora Keum, Chang Kyun Lee, Bo-In Lee, Seung-Bum Ryoo, Seong-Joon Koh, Miyoung Choi, Joo Sung Kim
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Youn I Choi, Tae Jun Kim, Dong Kyun Park, Jun-won Chung, Kyoung Oh Kim, Kwang An Kwon, Yoon Jae Kim
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Special Review: Consensus on TB in IBD

IBD

Asian Organization for Crohn's and Colitis and Asia Pacific Association of Gastroenterology consensus on tuberculosis infection in patients with inflammatory bowel disease receiving anti-tumor necrosis factor treatment. Part 2: management: Dong Il Park, Tadakazu Hisamatsu, Minhu Chen, Siew Chien Ng, Choon Jin Ooi, Shu Chen Wei, Rupa Banerjee, Ida Normiha Hilmi, Yoon Tae Jeen, Dong Soo Han, Hyo Jong Kim, Zhihua Ran, Kaichun Wu, Jiaming Qian, Pin-Jin Hu, Katsuyoshi Matsuoka, Akira Andoh, Yasuo Suzuki, Kentaro Sugano, Mamoru Watanabe, Toshifumi Hibi, Amarender S. Puri, Suk-Kyun Yang; Intest Res 2018;16(1):17-25. Published online January 18, 2018; DOI: https://doi.org/10.5217/ir.2018.16.1.17

Abstract PDF PubReader ePub

Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from 9 Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 2 of the statements comprised 3 parts: management of latent TB in preparation for anti-TNF therapy, monitoring during anti-TNF therapy, and management of an active TB infection after anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.

Citations

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Way Seah Lee, Katsuhiro Arai, George Alex, Suporn Treepongkaruna, Kyung Mo Kim, Chee Liang Choong, Karen S. C. Mercado, Andy Darma, Anshu Srivastava, Marion M. Aw
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Shruti Verma, Arshdeep Singh, Chandan Kakkar, Ashish Tripathi, Vandana Midha, Ajit Sood
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Fen Liu, Jian Tang, Lingna Ye, Jinyu Tan, Yun Qiu, Fan Hu, Jinshen He, Baili Chen, Yao He, Zhirong Zeng, Ren Mao, Qian Cao, Xiang Gao, Minhu Chen
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Suk-Kyun Yang
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The Korean Journal of Gastroenterology.2020; 75(1): 1. CrossRef
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Jihye Kim, Jong Pil Im, Jae-Joon Yim, Chang Kyun Lee, Dong Il Park, Chang Soo Eun, Sung-Ae Jung, Jeong Eun Shin, Kang-Moon Lee, Jae Hee Cheon
The Korean Journal of Gastroenterology.2020; 75(1): 29. CrossRef
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Xiaolong Ge, Huaying Liu, Shasha Tang, Yan Wu, Yipeng Pan, Wei Liu, Weilin Qi, Lingna Ye, Qian Cao, Wei Zhou
International Journal of Surgery.2020; 79: 294. CrossRef
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Rupa Banerjee, Raja Affendi Raja Ali, Shu Chen Wei, Shashi Adsul
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Comparison of outcomes of continuation/discontinuation of 5-aminosalicylic acid after initiation of anti-tumor necrosis factor-alpha therapy in patients with inflammatory bowel disease
Youn I Choi, Tae Jun Kim, Dong Kyun Park, Jun-won Chung, Kyoung Oh Kim, Kwang An Kwon, Yoon Jae Kim
International Journal of Colorectal Disease.2019; 34(10): 1713. CrossRef
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