Evidence-based clinical practice guidelines for inflammatory bowel disease 2020
JSGE · 2021 · Japan
Source and licence
- Authors
- Hiroshi Nakase, Motoi Uchino, Shinichiro Shinzaki et al.
- Title
- Evidence-based clinical practice guidelines for inflammatory bowel disease 2020
- Journal
- Journal of Gastroenterology, 2021
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC8137635
Licence statement of the original publication
Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Recommendation
- SBCE is as useful as CT enterography (CTE) and magnetic resonance enterography (MRE) for the assessment of small bowel disease activity or postoperative recurrence in patients with CD -confirmed bowel patency.Strong recommendation, moderate-quality evidence
- The use of MRE or magnetic resonance enterocolonography (MREC) is recommended for monitoring intestinal disease activity, evaluating mucosal healing and extraluminal disease, and evaluating treatment response.Strong recommendation, moderate-quality evidence
- It is recommended that the dose of 5-ASA in the maintenance therapy for UC be 2 g or more.Strong recommendation, high-quality evidence
- It is recommended that 5-ASA treatment reduces the risk of UC-associated CRC.Strong recommendation, low-quality evidence
- The NUDT15 gene R139C variant is useful for predicting acute severe leukopenia and severe alopecia induced by thiopurine, and we recommend confirming whether the NUDT15 gene R139C variant is present before the initiation of thiopurine.Strong recommendation, high-quality evidence
- We propose the use of thiopurines for the prevention of postoperative recurrence of CD.Weak recommendation, moderate-quality evidence
- Retreatment with the same anti-TNF-α agent for the relapse after discontinuation is recommended because it is generally effective and safe.Weak recommendation, low-quality evidence
Recommendations
- In the treatment of CD, combination therapy is recommended because it is more effective than monotherapy, which each drug is used separately.Strong recommendation, high-quality evidence
- In the treatment of UC, combination therapy is suggested, because it may be more effective compared to monotherapy, which each drug is used separately.Weak recommendation, moderate-quality evidence
Recommendation
- It is recommended that anti-TNF-α agents be administered to prevent endoscopic recurrence.Strong recommendation, moderate-quality evidence
- It is recommended to evaluate the long-term combination of anti-TNF-α agents and immunomodulaors from the viewpoint of usefulness and safety, considering the patient background, treatment course, and risk differences between Japan and Western countries.Strong recommendation, moderate-quality evidence
- It is recommended to use tofacitinib for UC patients refractory to anti-TNFα agentsWeak recommendation, moderate-quality evidence
- EBD is recommended for indicated intestinal stenosis in CD because it can avoid surgical intervention at least in the short-term.Strong recommendation, moderate-quality evidence
- Surveillance colonoscopy is useful and recommended for patients with total and left-sided UC starting at 8 years after the onset of UC.Strong recommendation, low-quality evidence
- Targeted biopsy is recommended for UC-associated CRC surveillance.Strong recommendation, moderate-quality evidence
- We propose that thromboprophylaxis in hospitalized IBD patients should be considered with an understanding of the increased risk of bleeding associated with the intervention.Weak recommendation, low-quality evidence
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.
Contents of the original publication
The section headings of the original.
- Introduction
- Definition and pathophysiology of IBD
- Statements
- Statements
- Statements
- Diagnosis
- Statements
- Statement
- Statements
- Statements
- Endoscopy and other imaging modalities
- Statements
- Statement
- Statements
- Recommendation
- Commentary
- Statements
- Recommendation
- Commentary
- Biomarkers
- Statement
- Statement
- Treatment
- Statements
- Current treatment strategy of IBD
- 5-Aminosalicyclic acid (ASA)
- Statements
- Statements
- Statement
- Statement
- Recommendation
- Commentary
- Recommendation
- Commentary
- Statement
- Commentary
- Nutritional therapy
- Statements
- Cytapheresis
- Statements
- Immunosuppressive drugs and biologics
- Statements
- Corticosteroids
- Statements
- Statement
- Statements
- Immunomodulators
- Statements
- Recommendation
- Commentary
- Recommendation
- Commentary
- Statement
- Commentary
- Calcineurin inhibitors
- Statements
- Statement
- Commentary
- Anti-TNF-α agents
- Statements
- Statement
- Recommendation
- Commentary
- Recommendations
- Commentary
- Recommendation
- Commentary
- Recommendation
- Commentary
- Statement
- Commentary
- Statement
- Commentary
- Statement
- Commentary
- Ustekinumab
- Statement
- Statement
- Commentary
- Statement
- Commentary
- Statement
- Commentary
- Statement
- Commentary
- Vedolizumab
- Statement
- Statement
- Statements
- Statements
- Statement
- Commentary
- Statement
- Commentary
- Tofacitinib
- Statement
- Statements
- Recommendation
- Commentary
- Endoscopic treatment for CD
- Recommendation
- Commentary
- Surgical treatment and colitic cancer
- Statements
- Recommendation
- Commentary
- Recommendation
- Commentary
- Statement
- Commentary
- Statement
- Commentary
- Statement
- Commentary
- Special situations
- Statements
- Statements
- Statements
- Recommendation
- Commentary
- Postscript
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