In the daily course RAD001 order of clinical work, the group felt that a global physician impression usually prevails. Clinicians rely on an empiric global scale based on the parameters articulated by the above statement. On the other hand, formal indexes are usually employed in clinical trial settings. Ulcerative colitis is usually characterized by relapsing

and remitting idiopathic inflammation of the colon and may affect extra intestinal sites. Level of agreement: a-94%, b-6%, c-0%, d-0%, e-0% Quality of evidence: II-2 Classification of recommendation: B All the studies from Asia-Pacific reflect the relapsing remitting nature of UC.57,59–63,73,74 An elegant study from South Korea documented high rates of cumulative relapse after 1, 5, and 10 years Tyrosine Kinase Inhibitor Library at 30%, 72%, and 88%, respectively.57 Extra intestinal sites of involvement

were noted to be within 6–20% in Asia Pacific.60–63,73,74 The group recognized that older retrospective studies may have under-reported these manifestations. The incidence of UC is rising in the Asia-Pacific region, with some exceptions. Level of agreement: a-73%, b-14%, c-13%, d-0%, e-0% Quality of evidence: II-2 Classification of recommendation: B From the available data, UC is increasing in many parts of the Asia Pacific region.58,75–77 Exceptions include Australia and New Zealand where the disease pattern follows the other Caucasian predominant populations in Europe and America.78 There are few epidemiological regional studies and true population based registries are only available in Japan and Korea.58,75,76 The rising trend seen clearly in the Far East may not apply to all Asian countries and all ethnicities. It is also difficult to establish whether any rise in incidence is a true increase and not due to increased awareness and diagnosis. The reason for this apparent increase has not been established but is almost certainly due to environmental factors. The most likely cause is thought to be associated with the

improved economic prosperity in the region and ‘Westernization’ of Asian countries leading to an increase in diseases that are common in the West but previously relatively rare see more in Asia.79–81 The incidence and prevalence of UC is lower in the Asia-Pacific region compared to the West, with some exceptions. Level of agreement: a-87%, b-13%, c-0%, d-0%, e-0% Quality of evidence: II-2 Classification of recommendation: B Available data suggest that overall, the incidence of UC in Asian countries ranges from 0.4 to 2.1 per 100 000 population.58,63,75,77,82 This is in contrast to the incidence rates of 6–15.6 and 10–20.3 per 100 000 in North America and North Europe, respectively.83 Similarly, the prevalence rates appear to be lower in Asia with rates ranging from 6 to 30 per 100 000 population58,63,75,77,82,84,85 compared to 37.5–229 and 21.4–243 per 100 000 population in North America and Europe, respectively.