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P237. Features of the Japanese clinical practice guidelines for Crohn's disease with reference to those in the western world

K. Matsuoka1, F. Ueno2, T. Matsui3, M. Watanabe4, T. Hibi1, 1Keio University School of Medicine, Gastroenterology and Hepatology, Tokyo, Japan, 2Ofuna Chuo Hospital, Kanagawa, Japan, 3Fukuoka University Chikushi Hospital, Gastroenterology, Fukuoka, Japan, 4Tokyo Medical and Dental University, Gastroenterology and Hepatology, Tokyo, Japan

Background

We have recently developed a set of clinical practice guidelines for Crohn's disease (CD) [J Gastroenterol, 2012, DOI 10.1007/s00535–012–0673–1]. These guidelines aim to provide appropriate clinical indicators to Japanese practitioners to improve the outcomes of CD patients. These guidelines are based on global literature-based evidence as well as evidence from Japan. The aim of this study is to introduce some distinct features of the Japanese guidelines for CD, which potentially contribute to the clinical practice for CD in the rest of the world.

Methods

We investigated different features of the Japanese guidelines for CD from those published by ECCO, the British Society of Gastroenterology (BSG), and the American College of Gastroenterology (ACG) in terms of developmental process and statements in those guidelines.

Results

The Japanese guidelines were developed based on the existing evidence with integration of consensus of Japanese experts. The criteria for recommendation grade were also determined by the level of evidence as well as the consensus of the experts. It is a distinct feature of the Japanese guidelines to disclose this process explicitly. This recommendation rating of the Japanese guidelines is thus useful to fill the gap between evidence and daily clinical practice. It should be also emphasized that the diagnostic criteria of CD established and widely used in Japan were employed in the Japanese guidelines. The statements in the 4 sets of guidelines mostly reached the same conclusions basically based on the same evidence. However, some statements in the Japanese guidelines reflect Japanese perspectives and evidence: e.g. 1) The Japanese guidelines recommend contrast radiographic examinations for diagnosis of the small intestinal lesions rather than MRI and CT, 2) Elemental diet and cytapheresis are more emphasized in the Japanese guidelines. 3) 5-aminosalitylate is not recommended in the western guidelines because of its minimal effect on CD, but it has a role in the management of CD in the Japanese guidelines because of its safety profile.

Conclusion

Since the Japanese guidelines for CD are primarily based on global literature-based evidence, most of the clinical indicators in them are consistent with those in other guidelines from the western world. Meanwhile, there are some distinctly different statements in the Japanese guidelines reflecting Japanese standard clinical practice, evidence, and the opinions of Japanese experts.