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      "@value" : "Medical management of active inflammatory bowel disease\n(IBD) depends on the extent and the severity of the disease\nestimated by both clinical and endoscopic parameters. Based\non these parameters a flare of IBD, either of ulcerative colitis\n(UC) or of Crohn’s disease (CD) can be mild, moderate\nor severe. Mild or moderate IBD is treated on an outpatient\nbasis, while severe disease requires hospitalization. Although\nin the literature there is no clear cut definition of resistance,\nwe characterize as refractory the disease that does not respond\nto drug treatment, consisting of salicylates and steroids\nin doses appropriate for the severity of the episode for a\nfour week period in combination with topical therapy. In severe\nIBD the critical period is much shorter (5 days).\nIn refractory mild IBD, steroids (prednisone 20-40 mg)\ncombined with a double dose of topical treatment are appropriate.\nIn refractory moderate disease, therapeutic options\nare: the intensive scheme of severe disease, immunomodulators,\nInfliximab or consideration for surgery. In\nrefractory severe cases cyclosporine (mainly for UC) or Infliximab\neither early or after cyclosporine failure appear to\nbe effective approaches, which must be compared to surgical\ntreatment in controlled clinical trials.\nIn conclusion, although refractory IBD is a challenge for the\nclinician there are several therapeutic options. Apart from\nold friends (steroids, immunomodulators, surgery) the new\ngroup of biologic agents, in the form of anti-TNF factor (Infliximab\nat present), has emerged as an option in the medical\nmanagement of moderate, severe and refractory IBD. Key words: Inflammatory bowel disease, IBD, ulcerative\ncolitis, Crohn’s disease, refractory IBD."
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