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A chronic illness has caused Japan’s longest-serving prime minister to resign.

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Japan’s longest-serving Prime Minister Shinzo Abe resigned Friday because a chronic illness resurfaced and he said he did not want it to affect his decision-making. 

Abe, 65, has for years suffered from ulcerative colitis, a disease that inflames the bowels. Concerns about Abe’s health began this summer and grew this month when he visited a Tokyo hospital two weeks in a row for unspecified health checkups. 

He has had the condition since he was a teenager. 

“It is gut-wrenching to have to leave my job before accomplishing my goals,” he said.

Abe has cultivated a strong relationship with President Donald Trump and the impact of his departure on U.S.-Japan ties, and world affairs, is not clear. 

There was no immediate reaction from the White House. 

According to the Center for Strategic and International Studies (CSIS), a Washington, D.C.-based foreign affairs and public policy think thank, no foreign leader has closer ties with Trump than Abe. “Since the 2016 presidential election,” CSIS wrote in a recent report, “the two leaders have met 20 times, played 5 rounds of golf, and had 32 phone calls, at times speaking twice a week.”

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Abe’s term ends in September 2021. He is expected to stay on until a new party leader is elected and formally approved by the parliament.

Abe was elected in 2012 and it is the second time he has resigned as prime minister as a result of his battles with ulcerative colitis. He last stepped down in 2007. 

He will leave office at a time when his approval ratings hit their lowest levels due to his handling of the coronavirus pandemic and its severe impact on the economy. 

A slew of political scandals have also dented his reputation. 

Shigeru Ishiba, a 63-year-old hawkish former defense minister and Abe’s archrival, is a favorite next leader in media surveys, though he is less popular within Abe’s ruling Liberal Democratic Party.

Among other potential successors named in Japanese media: Fumio Kishida, a former foreign minister; Defense Minister Taro Kono; Chief Cabinet Secretary Yoshihide Suga; and economic revitalization minister Yasutoshi Nishimura, who is currently in charge of coronavirus measures.

When he returned to office in 2012, Abe vowed to revitalize the nation and get its economy out of its deflationary doldrums with his “Abenomics” formula, which combines fiscal stimulus, monetary easing and structural reforms.

One of Abe’s major domestic successes has been his successful bid to host the 2020 Tokyo Olympics but that success was tarnished by the coronavirus pandemic that has forced its postponement until at least 2021. 

He has also strengthened Japan’s military and boosted spending on defense.

However, Abe has not been able to change a central pacifist tenet of Japan’s constitution – Article 9 – that bans the country from using its army for anything else but self-defense despite growing threats from China and North Korea. 

Japan instituted Article 9 in the aftermath of its defeat in World War II.

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Contributing: Associated Press

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