Skip to main content
Log in

Crohn's disease in Japan

Diagnostic criteria and epidemiology

  • Current Status
  • Published:
Diseases of the Colon & Rectum

Abstract

New diagnostic criteria for Crohn's disease and a review of Japanese epidemiologic studies are presented. New diagnostic criteria for Crohn's disease were established by the Research Committee of Inflammatory Bowel Disease, set up by the Japanese Ministry of Health and Welfare. For a definite diagnosis one of the following three conditions is required: 1) longitudinal ulcer or luminal deformity induced by longitudinal ulcer or cobblestone pattern, 2) intestinal small aphthous ulcerations arranged in a longitudinal fashion for at least three months plus noncaseating granulomas, and 3) multiple small aphthous ulcerations in both the upper and lower digestive tract not necessarily with longitudinal arrangement, for at least three months, plus noncaseating granulomas. Moreover, ulcerative colitis, ischemic enterocolitis, and acute infectious enterocolitis should be excluded. Data from the Japanese Ministry of Health and Welfare, in addition to data collected from two study groups, these being the two largest studies in Japan, are reviewed with regard to epidemiology. The number of patients with Crohn's disease has increased remarkably. The prevalence and the annual incidence of patients with Crohn's disease in Japan were estimated to be approximately 2.9 and 0.6 per 105 population in 1986, respectively, and 13.5 and 1.2 per 105 population in 1998. Characteristic features of Crohn's disease in Japan are that the male-female ratio exceeds 2, and that there is no second peak of incidence in the age group of 55 to 65 years. Clinically, Crohn's disease with only multiple small aphthous ulcerations, which is the earliest stage of the disease that is diagnosable, was found in 5 percent of patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Yoshida Y, Murata Y. Inflammatory bowel disease in Japan. Med Clin North Am 1990;74:67–90.

    Google Scholar 

  2. Yao T, Okada M, Fuchigami T,et al. The relationship between the radiological and clinical features in patients with Crohn's disease. Clin Radiol 1989;40:389–92.

    Google Scholar 

  3. Kimura A, Sasagawa T. Incidence of Crohn's disease in Japan. In: Shiratori T, Nakano H, eds. Proceedings of the International Symposium on Etiopathogenesis and Treatment of IBD. Tokyo: University of Tokyo Press, 1992:83–9.

    Google Scholar 

  4. Morita N, Toki S, Horihashi T,et al. Incidence and prevalence of inflammatory bowel disease in Japan: nationwide epidemiological survey during the year 1991. J Gastroenterol 1995;30(Suppl VIII):1–4.

    Google Scholar 

  5. Higashi A, Watanabe Y, Ozaka K, Hayashi K, Aoike A, Kawai K. Prevalence and mortality of ulcerative colitis and Crohn's disease in Japan. Gastroenterol Jpn 1988;23:521–6.

    Google Scholar 

  6. Yao T. Criteria for diagnosis of Crohn's disease (preliminary proposal). In: Muto T, ed. Annual report of the Research Committee of Inflammatory Bowel Disease. Tokyo: The Ministry of Health and Welfare of Japan, 1996:63–6.

    Google Scholar 

  7. Yao T. New criteria for the diagnosis of Crohn's disease. Stomach Intestine 1996;31:451–64.

    Google Scholar 

  8. Winship DN, Summers RW, Singleton JW,et al. National Cooperative Crohn's Disease Study: study design and conduct of the study. Gastroenterology 1979;77:829–42.

    Google Scholar 

  9. Binder V, Both H, Hansen PK,et al. Incidence and prevalence of ulcerative colitis and Crohn's disease in the County of Copenhagen, 1962 to 1978. Gastroenterology 1982;83:563–8.

    Google Scholar 

  10. Hiatt RA, Kaufman L. Epidemiology of inflammatory bowel disease in a defined north California population. West J Med 1988;149:541–6.

    Google Scholar 

  11. Lenard-Jones JE. Classification of inflammatory bowel disease. Scand J Gastroenterol 1989;24(Suppl 170):2–6.

    Google Scholar 

  12. Gollop JH, Phillips SF, Melton LJ, Zinsmeister AR. Epidemiologic aspects of Crohn's disease: a population based study in Olmsted County. Gut 1988;29:49–56.

    Google Scholar 

  13. Loftus EV, Silverstein MC, Sandborn WJ, Tremaine WJ, Harmsen WS, Zinsmeister AR. Crohn's disease in Olmsted County, Minnesota, 1940–1993: incidence, prevalence, and survival. Gastroenterology 1998;114:1161–8.

    Google Scholar 

  14. Moum B, Ekbom A, Vatn MH,et al. Inflammatory bowel disease: re-evaluation of the diagnosis in a prospective population based study in south eastern Norway. Gut 1997;40:328–32.

    Google Scholar 

  15. Munkholm P. Crohn's disease—occurrence, course and prognosis. An epidemiologic cohort study. Dan Med Bull 1997;40:287–302.

    Google Scholar 

  16. Kyle J. Crohn's disease in the northeastern and northern isles of Scotland: an epidemiological review. Gastroenterology 1992;103:392–9.

    Google Scholar 

  17. Thoeni RF. Idiopathic inflammatory disease of large and small bowel. In: Freeny PC, Stevenson GW, eds. Margulis and Burhenne's alimentary tract radiology. 5th ed. St Louis: Mosby, 1994:585–601.

    Google Scholar 

  18. Marshak RH, Lindner AE. Regional enteritis in radiology of the small intestine. Philadelphia: WB Saunders, 1970:158–222.

    Google Scholar 

  19. Kelvin FM, Herlinger H. Crohn's disease. In: Herlinger H, Maglinte DD, Birnbaum BA, eds. Clinical imaging of small intestine. 2nd ed. New York: Springer-Verlag, 1998:259–90.

    Google Scholar 

  20. Morson BC, Dawson IM, eds. Gastrointestinal pathology. 3rd ed. Boston: Blackwell Scientific Publications, 1990;258–76.

    Google Scholar 

  21. Greenstein AJ. Crohn's disease. Part 9. Surgical management and ultimate outcome. In: Haubrich WS, Schaffner F, Berk JE, eds. Bockus gastroenterology. 5th ed. Philadelphia: WB Saunders, 1995:1514–46.

    Google Scholar 

  22. Nishimata Y, Nishimata H, Ooi H,et al. Major and accessory findings for the diagnosis of Crohn's disease—longitudinal ulcers from the view points of radiologic diagnosis. Stomach Intestine 1996;31:465–78.

    Google Scholar 

  23. Hamilton SR, Morson BC. Crohn's disease. Part 1. Pathology. In: Haubrich WS, Schaffner F, Berk JE, eds. Bockus gastroenterology. 5th ed. Philadelphia: WB Saunders, 1995:1398–409.

    Google Scholar 

  24. Watanabe H, Enjoji M, Yao T. Pathomorphologic study of intestinal Crohn's disease. Stomach Intestine 1978;13:351–73.

    Google Scholar 

  25. Matsuda K, Watanabe H, Ajioka Y, Sasaki M, Saitoh H. Utility of new criteria for Crohn's disease. Stomach Intestine 1996;31:523–37.

    Google Scholar 

  26. Yao T, Seo M, Iwashita A,et al. Crohn's disease solely with aphthous lesion. Stomach Intestine 1990;25:571–84.

    Google Scholar 

  27. Hizawa K, Iida M, Kohrogi M,et al. Early recognition and progress of aphthous lesions. Radiology 1994;190:451–4.

    Google Scholar 

  28. Yao T, Sakurai T, Matsui T,et al. Crohn's disease exclusively composed of aphthas. Comparison with typical Crohn's disease and its clinical course. Stomach Intestine 1994;29:507–19.

    Google Scholar 

  29. Maekawa H, Hiwatashi N. Long-term course of Crohn's disease, with special reference to changes of radiographic findings. Stomach Intestine 1999;34:1211–26.

    Google Scholar 

  30. Matsumoto T, Iida M, Nakamura S,et al. Long-term clinical course in Crohn's disease of aphthous type. Stomach Intestine 1999;34:1267–76.

    Google Scholar 

  31. Iida M, Hizawa K, Aoyagi K,et al. Radiographic differential diagnosis of aphthoid lesions of the colon: focused on Crohn's disease with aphthoid lesions alone. Stomach Intestine 1993;28:397–410.

    Google Scholar 

  32. Fuchigami T, Osamura T, Sakai Y. Intestinal Behçet and simple ulcer. Stomach Intestine 1997;32:451–8.

    Google Scholar 

  33. Kojima N, Tominaga M, Okabe N,et al. Typhoid fever with multiple ulcers in the colon, report of a case. Stomach Intestine 1992;27:1451–6.

    Google Scholar 

  34. Yao T, Iwashita A. Upper gastrointestinal involvement of Crohn's disease. Stomach Intestine 1983;18:1323–34.

    Google Scholar 

  35. Iwashita A, Takemura S, Yao K,et al. Histopathological study on aphthoid lesions of the large intestine. Stomach Intestine 1993;28:385–95.

    Google Scholar 

  36. Hamada S, Takenaka K, Uchida Y,et al. Significance of biopsy in the diagnosis of Crohn's disease. Stomach Intestine 1986;21:611–22.

    Google Scholar 

  37. Iida M, Matsui T, Yao T, Iwashita A. Radiographic features in ischemic jejunoileitis: serial changes and comparison with pathologic findings. Gastrointest Radiol 1992;17:327–32.

    Google Scholar 

  38. Harima T, Yoshimura S, Yasutake R,et al. Pathological diagnosis of ischemic colitis and antibiotic associated colitis. Stomach Intestine 1986;21:623–32.

    Google Scholar 

  39. Suekane H, Iida M, Matsui T. Radiographic demonstration of longitudinal ulcers in patients with ulcerative colitis. Gastrointest Radiol 1990;15:333–7.

    Google Scholar 

  40. Hiwatashi N, Watanabe H, Maekawa H,et al. New criteria for diagnosis of Crohn's disease—with special reference of non-caseating epithelioid cell granuloma. Stomach Intestine 1996;31:493–504.

    Google Scholar 

  41. Health and Welfare Statistics Association. J Health Welfare Statistics. 1998;45:167,402.

    Google Scholar 

  42. Trallori G, Palli D, Saieva S,et al. A population-based study of inflammatory bowel disease in Florence over 15 years (1978–92). Scand J Gastroenterol 1996;31:892–9.

    Google Scholar 

  43. Whelan G. Inflammatory bowel disease. Part 2. Epidemiology. In: Haubrich W, Schaffver F, Berk JE, eds. Bockus gastroenterology. Vol. 2. 5th ed. Philadelphia: WB Saunders, 1995;1318–25.

    Google Scholar 

  44. Logan RF. Inflammatory bowel disease incidence: up, down or unchanged? Gut 1998;42:309–31.

    Google Scholar 

  45. Andres PG, Friedman LS. Epidemiology and the natural course of inflammatory bowel disease. Gastroenterol Clin North Am 1999;28:255–61.

    Google Scholar 

  46. Stenson WF. Inflammatory bowel disease. In: Yamada T, Alpers DH, Laive L, Owyang C, Powel DW, eds. Textbook of gastroenterology. Volume 2. 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 1999:1775–839.

    Google Scholar 

  47. Fonager K, Sørensen HT, Olsen J. Change in incidence of Crohn's disease and ulcerative colitis in Denmark. A study based on the national registry of patients 1981–1992. Int J Epidemiol 1997;26:1003–8.

    Google Scholar 

  48. Thompson NP, Fleming DM, Charlton J, Pounder RE, Wakefield AJ. Patients consulting with Crohn's disease in primary care in England and Wales. Eur J Gastroenterol Hepatol 1998;10:1007–12.

    Google Scholar 

  49. Bernstein CN, Blanchard JF, Rawsthorne P, Wajda A. Epidemiology of Crohn's disease and ulcerative colitis in a central Canadian province: a population-based study. Am J Epidemiol 1999;149:916–24.

    Google Scholar 

  50. Gossum AV, Adler M, Reuck M,et al. Epidemiology of inflammatory bowel disease in Brussels' area (1992–1993). Acta Gastroenterol Belg 1996;59:7–9.

    Google Scholar 

  51. Farmer RG, Hawk WA, Turnbull RB. Clinical patterns in Crohn's disease: a statistical study of 615 cases. Gastroenterology 1975;68:627–35.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

About this article

Cite this article

Yao, T., Matsui, T. & Hiwatashi, N. Crohn's disease in Japan. Dis Colon Rectum 43 (Suppl 10), S85–S93 (2000). https://doi.org/10.1007/BF02237231

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02237231

Key words

Navigation