Management of refractory Inflammatory Bowel Disease

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2007 (EN)
Management of refractory Inflammatory Bowel Disease (EN)

Goulas, S.S

Medical management of active inflammatory bowel disease (IBD) depends on the extent and the severity of the disease estimated by both clinical and endoscopic parameters. Based on these parameters a flare of IBD, either of ulcerative colitis (UC) or of Crohn’s disease (CD) can be mild, moderate or severe. Mild or moderate IBD is treated on an outpatient basis, while severe disease requires hospitalization. Although in the literature there is no clear cut definition of resistance, we characterize as refractory the disease that does not respond to drug treatment, consisting of salicylates and steroids in doses appropriate for the severity of the episode for a four week period in combination with topical therapy. In severe IBD the critical period is much shorter (5 days). In refractory mild IBD, steroids (prednisone 20-40 mg) combined with a double dose of topical treatment are appropriate. In refractory moderate disease, therapeutic options are: the intensive scheme of severe disease, immunomodulators, Infliximab or consideration for surgery. In refractory severe cases cyclosporine (mainly for UC) or Infliximab either early or after cyclosporine failure appear to be effective approaches, which must be compared to surgical treatment in controlled clinical trials. In conclusion, although refractory IBD is a challenge for the clinician there are several therapeutic options. Apart from old friends (steroids, immunomodulators, surgery) the new group of biologic agents, in the form of anti-TNF factor (Infliximab at present), has emerged as an option in the medical management of moderate, severe and refractory IBD. Key words: Inflammatory bowel disease, IBD, ulcerative colitis, Crohn’s disease, refractory IBD. (EN)




Hellenic Society of Gastroenterology (EN)

Annals of Gastroenterology; Volume 19, No 2 (2006) (EN)

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