Current status of 5-aminosalicylic acid in Crohn’s disease treatment: a nationwide survey and analysis of perspectives and practice patterns among inflammatory bowel disease physicians

Objective To investigate the perspectives and clinical practice patterns of inflammatory bowel disease (IBD) physicians regarding the use of 5-aminosalicylic acid (5-ASA) in Crohn’s disease (CD). Methods A 21-item questionnaire was distributed to IBD physicians across various regions in mainland China via WeChat. The survey evaluated prescription frequencies, indications, dosages, and physician rationales. The questionnaire was pilot-tested among 30 clinicians of varying seniority levels to ensure clarity and content validity. Responses were anonymized, and duplicate submissions were prevented through WeChat account verification. Statistical analysis employed the chi-square test. Results Among 615 respondents, 90.4% reported prescribing 5-ASA for CD patients. It was primarily used for mild disease (91.7%), colonic involvement (77.9%), and non-stricturing, non-penetrating phenotypes (91.4%). For induction therapy, 58.1% of physicians utilized 5-ASA, with 89.2% employing it in combination regimens (predominantly with corticosteroids, 90.3%). Furthermore, 83.1% prescribed 5-ASA for maintenance therapy. The primary rationales cited were its favorable safety profile (75.5%) and perceived efficacy in mild cases (68.2%). Conclusions Despite unequivocal evidence and international guidelines recommending against the routine use of 5-ASA in CD, it remains pervasively prescribed by Chinese clinicians. This highlights a profound discrepancy between evidence-based guidance and real-world practice. Such therapeutic inertia risks delaying the initiation of highly effective therapies, underscoring an urgent need for targeted continuing medical education to optimize CD management.