Journal List > Korean J Gastroenterol > v.60(5) > 1007018

TOOLS
Park, Cheon, Ye, Choi, Kim, Kim, Kim, Jeen, Park, Han, Yang, and Kim: A Survey of Actual Clinical Application Patterns in Korean Diagnostic Guidelines for Inflammatory Bowel Disease
Original Article
Alimentary Tract
The Korean Journal of Gastroenterology

The Korean Journal of Gastroenterology 2012; 60(5): 292-299.

Published online: 22 November 2012

DOI: https://doi.org/10.4166/kjg.2012.60.5.292

A Survey of Actual Clinical Application Patterns in Korean Diagnostic Guidelines for Inflammatory Bowel Disease

Soo Jung Park, Jae Hee Cheon, Byong Duk Ye1, Chang Hwan Choi2, You Sun Kim3, Young-Ho Kim4, Joo Sung Kim5, Yoon Tae Jeen6, Young Sook Park7, Dong Soo Han8, Suk-Kyun Yang1, Won Ho Kim

Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

1Department of Internal Medicine, Ulsan University College of Medicine, Seoul, Korea.

2Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.

3Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea.

4Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.

5Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

6Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.

7Department of Internal Medicine, Eulji University College of Medicine, Seoul, Korea.

8Department of Internal Medicine, Hanyang University College of Medicine, Guri, Korea.

Correspondence to: Yoon Tae Jeen, Department of Internal Medicine, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 136-705, Korea. Tel: +82-2-920-6555, Fax: +82-2-953-1943, ytjeen@korea.ac.kr

Received 29 June 2012       Revised 30 July 2012       Accepted 31 July 2012

Copyright © 2012 The Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

The aim of this study was to analyze the actual application patterns of how Korean diagnostic guidelines for inflammatory bowel disease (IBD) were applied in clinical practice.

Methods

Questionnaires regarding guidelines for ulcerative colitis (UC), Crohn's disease (CD), intestinal Behçet's disease (BD) and intestinal tuberculosis (TB), were distributed during the 2011 Korean Association for the Study of Intestinal Disease annual conference, and e-mail survey was additionally conducted. Forty eight questionnaires were collected.

Results

Most of responders (79.2%) were working at secondary (≥500 beds) or tertiary referral centers. For the necessity of guidelines, 93.8% of responders gave positive answers in UC; 95.8% in CD; 81.3% in BD; 91.7% in TB. Of the clinicians, 95.8%, 91.7%, 64.6%, 77.1% had read UC, CD, BD and TB guideline, and 87.0%, 93.2%, 90.3%, and 92.0% replied that diagnostic guidelines for UC, CD, BD and TB were helpful in practice, respectively. Practice patterns were changed in 39.1%, 33.2%, 41.9%, and 54.1% of responders by UC, CD, BD and TB guidelines, respectively. For the needs of update, 58.7% of responders answered 'yes' in UC, 54.5% in CD, 51.6% in BD and 48.7% in TB. There were differences between recommendations and practice patterns, including colonoscopy surveillance in UC, radiological examinations for small bowel in CD and for intestinal obstruction in UC, or biopsy method in UC, CD and TB, and diagnostic criteria in BD.

Conclusions

Although most of responders perceived the Korean diagnostic guidelines for IBD, there were differences between recommendations of guidelines and actual practice patterns. Therefore, the publicity and revision of diagnostic guidelines are important to reconcile theory and practice.

Keywords: Diagnostic guideline, Ulcerative colitis, Crohn's disease, Intestinal Behçet's disease, Intestinal tuberculosis

Figures and Tables

Table 1
Baseline Characteristics of the Responders (n=48)
kjg-60-292-i001

Values are presented as number (%) or median (range).

Table 2
Clinical Application of Korean Diagnostic Guidelines according to the Diseases
kjg-60-292-i002

Values are presented as number of responders (%).

Notes

Financial support: This study was supported by health and medical technology development project research funds of Minister for Health, Welfare and Family Affairs (No. A080588).

Conflict of interest: None.

References

1. Carter MJ, Lobo AJ, Travis SP. IBD Section, British Society of Gastroenterology. Guidelines for the management of inflammatory bowel disease in adults. Gut. 2004. 53:Suppl 5. V1–V16.
2. Stange EF, Travis SP, Vermeire S, et al. European Crohn's and Colitis Organisation. European evidence based consensus on the diagnosis and management of Crohns disease: definitions and diagnosis. Gut. 2006. 55:Suppl 1. i1–i15.
3. Yao T, Matsui T, Hiwatashi N. Crohn's disease in Japan: diagnostic criteria and epidemiology. Dis Colon Rectum. 2000. 43:10 Suppl. S85–S93.
4. Choi CH, Jung SA, Lee BI, Lee KM, Kim JS, Han DS. IBD Study Group of the Korean Association of the Study of Intestinal Diseases. Diagnostic guideline of ulcerative colitis. Korean J Gastroenterol. 2009. 53:145–160.
5. Ye BD, Jang BI, Jeen YT, Lee KM, Kim JS, Yang SK. IBD Study Group of the Korean Association of the Study of Intestinal Diseases. Diagnostic guideline of Crohn's disease. Korean J Gastroenterol. 2009. 53:161–176.
6. Cheon JH, Shin SJ, Kim SW, Lee KM, Kim JS, Kim WH. IBD Study Group of the Korean Association of the Study of Intestinal Diseases. Diagnosis of intestinal Behçet's disease. Korean J Gastroenterol. 2009. 53:187–193.
7. Kim YS, Kim YH, Lee KM, Kim JS, Park YS. IBD Study Group of the Korean Association of the Study of Intestinal Diseases. Diagnostic guideline of intestinal tuberculosis. Korean J Gastroenterol. 2009. 53:177–186.
8. Deutsch DE, Olson AD. Colonoscopy or sigmoidoscopy as the initial evaluation of pediatric patients with colitis: a survey of physician behavior and a cost analysis. J Pediatr Gastroenterol Nutr. 1997. 25:26–31.
9. Fefferman DS, Farrell RJ. Endoscopy in inflammatory bowel disease: indications, surveillance, and use in clinical practice. Clin Gastroenterol Hepatol. 2005. 3:11–24.
10. Nikolaus S, Schreiber S. Diagnostics of inflammatory bowel disease. Gastroenterology. 2007. 133:1670–1689.
11. Plevy S. Do serological markers and cytokines determine the indeterminate? J Clin Gastroenterol. 2004. 38:5 Suppl 1. S51–S56.
12. Konikoff MR, Denson LA. Role of fecal calprotectin as a biomarker of intestinal inflammation in inflammatory bowel disease. Inflamm Bowel Dis. 2006. 12:524–534.
13. Langhorst J, Elsenbruch S, Mueller T, Rueffer A, Spahn G, Michalsen A, et al. Comparison of 4 neutrophil-derived proteins in feces as indicators of disease activity in ulcerative colitis. Inflamm Bowel Dis. 2005. 11:1085–1091.
14. Poullis A, Foster R, Northfield TC, Mendall MA. Review article: faecal markers in the assessment of activity in inflammatory bowel disease. Aliment Pharmacol Ther. 2002. 16:675–681.
15. Vermeire S, Van Assche G, Rutgeerts P. Laboratory markers in IBD: useful, magic, or unnecessary toys? Gut. 2006. 55:426–431.
16. Lee YJ, Yang SK, Byeon JS, et al. Analysis of colonoscopic findings in the differential diagnosis between intestinal tuberculosis and Crohn's disease. Endoscopy. 2006. 38:592–597.
17. Toms AP, Barltrop A, Freeman AH. A prospective randomised study comparing enteroclysis with small bowel follow-through examinations in 244 patients. Eur Radiol. 2001. 11:1155–1160.
18. Bernstein CN, Boult IF, Greenberg HM, van der Putten W, Duffy G, Grahame GR. A prospective randomized comparison between small bowel enteroclysis and small bowel follow-through in Crohn's disease. Gastroenterology. 1997. 113:390–398.
19. Pulimood AB, Peter S, Ramakrishna B, et al. Segmental colonoscopic biopsies in the differentiation of ileocolic tuberculosis from Crohn's disease. J Gastroenterol Hepatol. 2005. 20:688–696.
20. International Study Group for Behçet's Disease. Criteria for diagnosis of Behçet's disease. Lancet. 1990. 335:1078–1080.
21. Mizushima Y. Revised diagnostic criteria for Behçet's disease in 1987. Ryumachi. 1988. 28:66–70.
22. Cheon JH, Han DS, Park JY, et al. Korean IBD Study Group. Development, validation, and responsiveness of a novel disease activity index for intestinal Behçet's disease. Inflamm Bowel Dis. 2011. 17:605–613.
23. Kalvaria I, Kottler RE, Marks IN. The role of colonoscopy in the diagnosis of tuberculosis. J Clin Gastroenterol. 1988. 10:516–523.
24. Bhargava DK, Kushwaha AK, Dasarathy S, Shriniwas , Chopra P. Endoscopic diagnosis of segmental colonic tuberculosis. Gastrointest Endosc. 1992. 38:571–574.
25. Marshall JB. Tuberculosis of the gastrointestinal tract and peritoneum. Am J Gastroenterol. 1993. 88:989–999.
26. Lingenfelser T, Zak J, Marks IN, Steyn E, Halkett J, Price SK. Abdominal tuberculosis: still a potentially lethal disease. Am J Gastroenterol. 1993. 88:744–750.
27. Ko BS, Kim BG, Kim JS, Jung HC, Song IS. A case of cure with secondary rescue regimen of tuberculosis in a patient with tuberculous colitis that failed to respond to primary drugs. Korean J Gastroenterol. 2002. 39:299–303.
28. Yun SK, Jung IK, Kim HS, et al. A case of colonic tuberculosis cured by secondary anti-tuberculosis medicine. Korean J Gastrointest Endosc. 1998. 18:591–596.
TOOLS
ORCID iDs

Byong Duk Ye
https://orcid.org/http://orcid.org/0000-0001-6647-6325

You Sun Kim
https://orcid.org/http://orcid.org/0000-0002-5156-3458

Similar articles