Second Korean guidelines for the management of Crohn's disease

Abstract

Crohn's disease (CD) is a chronic, progressive, and disabling inflammatory bowel disease (IBD) with an uncertain etiopathogenesis. CD can involve any site of the gastrointestinal tract from the mouth to the anus, and is associated with serious complications, such as bowel strictures, perforations, and fistula formation. The incidence and prevalence rates of CD in Korea are still lower compared with those in Western countries, but they have been rapidly increasing during the recent decades. Although there are no definitive curative modalities for CD, various medical and surgical therapies have been applied for the treatment of this disease. Concerning CD management, there have been substantial discrepancies among clinicians according to their personal experience and preference. To suggest recommendable approaches to the diverse problems of CD and to minimize the variations in treatment among physicians, guidelines for the management of CD were first published in 2012 by the IBD Study Group of the Korean Association for the Study of Intestinal Diseases. These are the revised guidelines based on updated evidence, accumulated since 2012. These guidelines were developed by using mainly adaptation methods, and encompass induction and maintenance treatment of CD, treatment based on disease location, treatment of CD complications, including stricture and fistula, surgical treatment, and prevention of postoperative recurrence. These are the second Korean guidelines for the management of CD and will be continuously revised as new evidence is collected.

Regional variations in the use of biologics and immunomodulators among Korean patients with inflammatory bowel diseases

“…In South Korea, biologics can be used in patients with moderate to severe CD (CD activity index ≥ 220) who are unresponsive to corticosteroids and thiopurines or who are not tolerant of the treatments. 6 Biologics can also be used in patients with moderate to severe UC (May score 6 to 12 and endoscopy subscore ≥ 2) who have no response to corticosteroids or thiopurine or are not tolerant of the treatments. 7 Thiopurines are used to maintain remission in steroid-dependent or steroid-refractory CD and UC.…”

“…7 Thiopurines are used to maintain remission in steroid-dependent or steroid-refractory CD and UC. 6,7 The date of IBD registration in the HIRA database was regarded as the date of diagnosis. The source population for this study consisted of all NHI claims data from 2008 to 2016.…”

“…2,3 There are several pharmacotherapeutic options available for induction and maintenance of remission in IBD, including 5-aminosalicylic acids (5-ASA), immunomodulators such as thiopurines, and biologics such as anti-tumor necrosis factor alpha agents (infliximab and adalimumab). [4][5][6][7] While all these drugs can be effective for IBD treatment, there is no single ideal drug for all patients. This may be partly because of the varied pathways of inflammation and abnormal immune response in individual patients.…”

“…Although the IBD incidence rate in South Korea is still lower than the rates in Western countries, it has been rapidly rising. 6,7 Accordingly, the burden of IBD in South Korea will also rise concurrently. However, little is known about the variation in IBD treatment in South Korea.…”

Adalimumab or infliximab: which is better for perianal fistula in Crohn's disease?

“…Although antibiotics improve fistula symptoms and may contribute to healing, they do not induce complete fistula closure, and the fistula often deteriorates after their discontinuation. In addition, metronidazole should be used cautiously, because of adverse events associated with long-term use 34…”