Intestinal Research

Statement

IBD

Role of 5-aminosalicylic acid in ulcerative colitis management in 8 Asian territories: a physician survey: Julajak Limsrivilai, Allen Yu-hung Lai, Silvia T. H. Li, Murdani Abdullah, Raja Affendi Raja Ali, Satimai Aniwan, Hoang Huu Bui, Jen-Wei Chou, Ida Normiha Hilmi, Wee Chian Lim, Jose Sollano, Michelle Mui Hian Teo, Shu-Chen Wei, Wai Keung Leung; Intest Res 2025;23(2):117-128. Published online January 6, 2025; DOI: https://doi.org/10.5217/ir.2024.00085

Abstract PDF Supplementary Material PubReader ePub: Clinical guidelines typically endorse conventional therapies such as 5-aminosalicylic acid (5-ASA) as the mainstay of ulcerative colitis management. However, the degree of adoption and application of guideline recommendations by physicians within Asia remains unclear. This study aims to understand the prescribing patterns of 5-ASA and implementation of current guideline recommendations across Asian clinical practice. A physician survey was conducted among inflammatory bowel disease specialists in 8 Asian territories to understand practices and preferences in ulcerative colitis management, focusing on the use of 5-ASA and concordance with guideline recommendations. Survey findings were validated by country experts in diverse healthcare settings. Subgroup analyses stratified data by income levels and treatment reimbursement status. Ninety-eight valid responses were received from inflammatory bowel disease specialists or gastroenterologists among 8 economic entities. Significant differences were found in clinical practices and treatment preferences for ulcerative colitis management among different income-level and government-subsidy groups. Survey results are summarized in 8 findings that illustrate trends in 5-ASA use and guideline implementation across Asian territories. This study emphasizes socioeconomic factors that impact the adoption of guideline recommendations in real-world practice. Our findings indicate an eclectic approach to guideline implementation across Asia, based on resource availability and feasibility of treatment goals.

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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

Abstract PDF PubReader ePub: 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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Original Articles

Inflammatory Bowel Diseases

Temporal trend in the natural history of ulcerative colitis in a country with a low incidence of ulcerative colitis from 2000 through 2018: Satimai Aniwan, Julajak Limsrivilai, Supot Pongprasobchai, Nonthalee Pausawasdi, Piyapan Prueksapanich, Natanong Kongtub, Rungsun Rerknimitr; Intest Res 2021;19(2):186-193. Published online August 18, 2020; DOI: https://doi.org/10.5217/ir.2020.00028

Abstract PDF PubReader ePub

Background/Aims
The incidence of ulcerative colitis (UC) in Thailand (crude incidence rate of 0.28 per 100,000 persons) is much lower than in the West. The burden of UC varies in different populations. The aim of this study was to evaluate the natural history of UC over the two decades in Bangkok, Thailand.
Methods
This retrospective study included patients who were diagnosed with UC between 2000 and 2018 in 2 university hospitals. To evaluate changes in the disease course, we stratified patients into 2000–2009 cohort and 2010–2018 cohort. The cumulative probability of endoscopic healing, UC-related hospitalization and colectomy was estimated using the Kaplan-Meier method.
Results
A total of 291 UC patients were followed for total of 2,228 person-years. Comparison between 2 cohorts, there were no differences in disease pattern and severity whereas an increase in the combination use of oral and topical mesalamine and the early use of thiopurine was observed. Only 1% of patients for each cohort required biologic agent at 5 years. The rate of achieving mucosal healing increased from 15% to 46% at 3 years (P< 0.01). The rate of UC-related hospitalization decreased from 30% to 21% at 5 years (P< 0.05). The rate of colectomy decreased from 6% to 2% at 5 years (P< 0.05).
Conclusions
The natural history of UC in a low incidence country was less aggressive than the West. Over the past two decades, the rates of UC-related hospitalization and colectomy have been decreasing which were similar to the West.

Citations

Citations to this article as recorded by

Development of a bio-inspired phagocytic stable nanoghost with anti-inflammatory properties for management of inflammation in ulcerative colitis
Ahmed Mohsin Huran Al-Jawadri, Zahra Karami, Ismaeil Haririan, Mohammad Akrami, Mahdi Gholami
Journal of Drug Targeting.2025; : 1. CrossRef
Impact of Sarcopenia on Clinical Course of Inflammatory Bowel Disease in Korea
Kwangwoo Nam, Jae Yong Lee, Yousun Ko, Kyung Won Kim, Ho-Su Lee, Seung Wook Hong, Jin Hwa Park, Sung Wook Hwang, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byoun, Seung-Jae Myung, Suk-Kyun Yang, Sang Hyoung Park
Digestive Diseases and Sciences.2023; 68(6): 2165. CrossRef
Comparison of 1-Year Colectomy Risk Between the US and Korean Patients with Acute Severe Ulcerative Colitis: A Propensity Score Matching Analysis
Eun Soo Kim, Kyeong Ok Kim, Byung Ik Jang, Eun Young Kim, Yoo Jin Lee, Hyun Seok Lee, Joon Seop Lee, Sung Kook Kim, Yun Jin Jung, Sang-Bum Kang, Manasi Agrawal, Ryan Ungaro, Jean-Frederic Colombel
Digestive Diseases and Sciences.2022; 67(7): 2866. CrossRef
Infliximab versus Adalimumab: Can We Choose the Right One for the Right Patients with Ulcerative Colitis?
Sang Hyoung Park, Byong Duk Ye, Suk-Kyun Yang
Gut and Liver.2022; 16(1): 138. CrossRef
Impact of Immunosuppressive Therapy on the Performance of Latent Tuberculosis Screening Tests in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis
Chan Hyuk Park, Jung Ho Park, Yoon Suk Jung
Journal of Personalized Medicine.2022; 12(3): 507. CrossRef
Update on the epidemiology of inflammatory bowel disease in Asia: where are we now?
Sang Hyoung Park
Intestinal Research.2022; 20(2): 159. CrossRef
Oral beclomethasone dipropionate as an add-on therapy and response prediction in Korean patients with ulcerative colitis
Kyuwon Kim, Hee Seung Hong, Kyunghwan Oh, Jae Yong Lee, Seung Wook Hong, Jin Hwa Park, Sung Wook Hwang, Dong-Hoon Yang, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Byong Duk Ye, Sang Hyoung Park
The Korean Journal of Internal Medicine.2022; 37(6): 1140. CrossRef
Inflammatory bowel disease in Korea: epidemiology and pathophysiology
Jung Won Lee, Chang Soo Eun
The Korean Journal of Internal Medicine.2022; 37(5): 885. CrossRef
What Are the Different Phenotypes of Inflammatory Bowel Disease in Asia?
Su Bee Park, Jin Young Yoon, Jae Myung Cha
Gut and Liver.2022; 16(5): 676. CrossRef
Natural history of inflammatory bowel disease: a comparison between the East and the West
Eun Mi Song, Suk-Kyun Yang
Intestinal Research.2022; 20(4): 418. CrossRef
The epidemiology of inflammatory bowel disease in Asia and Asian immigrants to Western countries
Satimai Aniwan, Priscila Santiago, Edward V. Loftus, Sang Hyoung Park
United European Gastroenterology Journal.2022; 10(10): 1063. CrossRef
Current status of IBD and surgery of Crohn's disease in Thailand
Woramin Riansuwan, Julajak Limsrivilai
Annals of Gastroenterological Surgery.2021; 5(5): 597. CrossRef
Endoscopic Mucosal Healing as a Treatment Target in Ulcerative Colitis: Does It Have the Same Role in Asian Patients?
Suk-Kyun Yang, Sang Hyoung Park, Byong Duk Ye
Gut and Liver.2021; 15(6): 942. 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

Citations to this article as recorded by

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

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