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Practices and perceptions of 5-aminosalicylic acid use in Crohn’s disease: a nationwide survey of physicians in Korea by KASID Guidelines Taskforce Team
June Hwa Bae, Seung Yong Shin, Dong Hyun Kim, Seung Min Hong, Eun Mi Song, Ji Eun Kim, Young Joo Yang, Jiyoung Yoon, Sang-Bum Kang, Eun Soo Kim, Sung Eun Kim, Seong-Jung Kim, Jun Lee, Soo-Young Na, Soo Jung Park, Sang Hyoung Park, Won Moon, Sung-Ae Jung, KASID Guidelines Taskforce Team of the Korean Association for the Study of the Intestinal Diseases (KASID)
Intest Res 2025;23(4):491-501.   Published online October 28, 2025
DOI: https://doi.org/10.5217/ir.2025.00211
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background/Aims
Despite international guidelines recommending against the use of 5-aminosalicylic acid (5-ASA) for Crohn’s disease (CD), it remains widely prescribed. This study aimed to investigate current patterns of 5-ASA use and physicians’ perceptions of its efficacy among Korean specialists.
Methods
A nationwide online survey was conducted in August 2025 targeting Korean gastroenterologists and colorectal surgeons managing inflammatory bowel disease. The questionnaire included 19 items addressing prescribing behaviors, perceived efficacy, and clinical decision-making regarding 5-ASA in CD.
Results
A total of 118 out of 124 physicians (95.2%) responded to the survey. The majority (67.8%) reported prescribing 5-ASA to more than half of their patients with CD. Standard to high doses ( > 2 g/day) were commonly used (94.9%), and timedependent formulations were preferred (92.4%). Although 55.1% used 5-ASA irrespective of disease location, it was frequently prescribed for colonic/ileocolonic disease (57.7%). Physicians primarily used 5-ASA in cases of non-active or mildly active CD. Notably, over 70% of respondents perceived 5-ASA to have a marginal yet beneficial effect on clinical remission, biomarker improvement, and mucosal healing. Approximately one-third of physicians reported continuing 5-ASA even after initiating biologics or small molecules.
Conclusions
This survey reveals a substantial gap between clinical guidelines and current practice in Korea regarding 5-ASA use for CD. Many physicians continue to view 5-ASA as a relevant option, particularly for patients with low inflammatory burden. These discrepancies likely reflect practical factors such as clinical experience and drug characteristics, which should be carefully considered before excluding 5-ASA from CD management.
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Endoscopy
Effect of gut microbiome on minor complications after a colonoscopy
Jae Hyun Kim, Youn Jung Choi, Hye Jung Kwon, Kyoungwon Jung, Sung Eun Kim, Won Moon, Moo In Park, Seun Ja Park
Intest Res 2021;19(3):341-348.   Published online November 10, 2020
DOI: https://doi.org/10.5217/ir.2020.00057
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background/Aims
Minor complications that might occur after colonoscopy, including abdominal discomfort, bloating, diarrhea, and constipation, could a barrier for patients to undergo a screening colonoscopy. In this study, we aimed to identify the effect of gut microbial diversity and composition on minor complications after colonoscopy.
Methods
A total of 24 healthy subjects provided their stools before bowel preparation and on the 7th and 28th day after colonoscopy. On the 7th day after colonoscopy, the presence of minor complications was investigated using a questionnaire. We divided patients into 2 groups, the no complication group and complications group. The fecal microbial diversity, distribution, and composition were then compared between the groups.
Results
Five of the 24 subjects reported that they had undergone minor complications after colonoscopy. Most of the symptoms were mild and self-limited, but 1 patient needed medication. Interestingly, the Firmicutes/Bacteroidetes ratio of the initial stool samples before bowel preparation in the complication group was significantly higher than that in no complication group. After bowel preparation, the Firmicutes/Bacteroidetes ratio of the complication group decreased, but not in the no complication group. The microbial diversity of the no complication group decreased after bowel preparation, but not in the complication group.
Conclusions
The gut microbial composition and diversity before and after bowel preparation could be considered as one of the causes of minor complications after colonoscopy. Further studies are needed to delineate the role of gut microbiota in the occurrence of minor complications after colonoscopy.

Citations

Citations to this article as recorded by  
  • Alteration in gut microbiota after colonoscopy: proposed mechanisms and the role of probiotic interventions
    Hyeong Ho Jo, Moon Young Lee, Se Eun Ha, Dong Han Yeom, Yong Sung Kim
    Clinical Endoscopy.2025; 58(1): 25.     CrossRef
  • Effects of Brown Rice, Meal Replacements, and Anti-Obesity Drugs on Mitochondria in Obese Rats
    Dian Handayani, Anisa Handayani, Achmad Rudijanto, Puspita Nuraissa, Widya Rahmawati, Xu-Feng Huang
    Diabetes, Metabolic Syndrome and Obesity.2025; Volume 18: 3151.     CrossRef
  • Fecal Microbiota Transplantation for Inflammatory Bowel Disease: Where We Stand and What Is Next
    Dai Ishikawa, Xiaochen Zhang, Kei Nomura, Akihito Nagahara
    Inflammatory Intestinal Diseases.2025; 10(1): 371.     CrossRef
  • Depressive Symptoms and Gut Microbiota after Bowel Preparation and Colonoscopy: A Pre–Post Intervention Study
    Amelia J. McGuinness, Martin O’Hely, Douglas Stupart, David Watters, Samantha L. Dawson, Christopher Hair, Michael Berk, Mohammadreza Mohebbi, Amy Loughman, Glenn Guest, Felice N. Jacka
    Microorganisms.2024; 12(10): 1960.     CrossRef
  • Benefits of Probiotic Pretreatment on the Gut Microbiota and Minor Complications after Bowel Preparation for Colonoscopy: A Randomized Double-Blind, Placebo-Controlled Pilot Trial
    Dooheon Son, Youn Jung Choi, Min Young Son, Won Moon, Seun Ja Park, Sanghyun Lim, Jae Hyun Kim
    Nutrients.2023; 15(5): 1141.     CrossRef
  • Key determinants of success in fecal microbiota transplantation: From microbiome to clinic
    Serena Porcari, Nicolas Benech, Mireia Valles-Colomer, Nicola Segata, Antonio Gasbarrini, Giovanni Cammarota, Harry Sokol, Gianluca Ianiro
    Cell Host & Microbe.2023; 31(5): 712.     CrossRef
  • Colonoscopy: body and psyche. Can psychiatry contribute to the quality of the examination?
    Adam Zaczek, Robert Pudlo
    Current Problems of Psychiatry.2023; 24: 253.     CrossRef
  • CO2 Is Beneficial to Gut Microbiota Homeostasis during Colonoscopy: Randomized Controlled Trial
    Xue Yang, Wen-Bo Xiu, Jin-Xia Wang, Liang-Ping Li, Chong He, Cai-Ping Gao
    Journal of Clinical Medicine.2022; 11(18): 5281.     CrossRef
  • Novel frontiers of agents for bowel cleansing for colonoscopy
    Milena Di Leo, Andrea Iannone, Monica Arena, Giuseppe Losurdo, Maria Angela Palamara, Giuseppe Iabichino, Pierluigi Consolo, Maria Rendina, Carmelo Luigiano, Alfredo Di Leo
    World Journal of Gastroenterology.2021; 27(45): 7748.     CrossRef
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