In the current issue of Intestinal Research, Jun et al. [6] investigated the differences in the diagnosis and management of the infectious complications in patients with IBD across Asian countries through a multinational online questionnaire survey. A total of 384 physicians including both IBD specialists (55.0%) and non-specialists from multiple countries or regions responded to questions regarding diagnosis (17 items), treatment (33 items), infection (22 items), and vaccination (15 items) for infectious diseases in real-world clinical practice. Most responders were from Korea (28.6%), China (25.8%), and Japan (24.2%). Although general similarities were noted across the Asian countries, variations in the approaches to infectious complications were observed, reflecting the different epidemiological perspectives of infections. In the treatment of Clostridium difficile infection (CDI), Korean (n = 70, 63.6%) and Chinese (n = 51, 51.5%) physicians preferred vancomycin, whereas Japanese (n = 62, 66.7%) physicians preferred metronidazole. For the treatment of latent tuberculosis infection, physicians in Korea (n = 88, 80.0%) and China (n = 46, 46.5%) preferred a 3-month course of isoniazid and rifampin, whereas physicians in Japan (n = 71, 76.3%) favored a 9-month course of isoniazid. Moreover, unlike Japanese physicians, Korean (n = 89, 80.9%) and Chinese physicians (n = 48, 48.5%) were likely to vaccinate patients lacking hepatitis B virus (HBV) surface antigen given the prevalence rates of HBV infection and chronic HBV hepatitis are higher in Korea and China than in Japan [7].

In a previous study, Yang et al. [8] also investigated infectious complications in Asian patients with IBD using a questionnaire survey. They found that most physicians considered tissue cytomegalovirus (CMV) DNA as an index for the diagnosis of CMV colitis. In addition, more than 80% of hospitals surveyed had the test for CMV immunohistochemistry. More than 60% of physicians agreed to routinely vaccinate patients with IBD if the hepatitis B surface antigen test was negative. Most physicians preferred metronidazole as the first choice for patients with CDI, followed by vancomycin [8]. However, of importance, this study only recruited 83 physicians and included 11 questionnaire items. In contrast, the study conducted by Jun et al. [6] included a large number of Asian physicians from various countries, and more than half of them were IBD specialists, although there might be inherent selection bias due to the low response rate (2.4%). The study by Jun et al. enhanced our understanding of real-world clinical practices around infectious complications associated with IBD in Asian countries. Consequently, the findings have the potential to motivate physicians to develop practical and appropriate guidelines for managing infectious complications in the Asian IBD population.

Well-organized Western guidelines on the diagnosis and management for infectious complications of IBD exist [5,9,10]. Clinical practice guidelines of CDI by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America recommend oral vancomycin as the first-line treatment for patients with an initial CDI episode [9]. The updated 2020 latent tuberculosis infection treatment guidelines prefer a short-course (3–4 months) of rifamycin-based treatment regimens over a longer-course (6–9 months) of isoniazid monotherapy [10]. The latest ECCO guidelines for IBD recommend that HBV serology should be performed for all patients with IBD and that they should be vaccinated against hepatitis B to achieve an anti-hepatitis B surface antibody level of > 10 IU/L [5]. Understanding the differences in the diagnosis and treatment of infectious complications between Asian and Western countries is crucial for management of Asian patients with IBD. According to the study by Jun et al., it is believed that each Asian country adheres to the latest guidelines customized to their specific circumstances. However, development of guidelines for infectious complications tailored to Asian patients with IBD is still warranted in the future.