Abstract
Ulcerative colitis is an idiopathic chronic inflammatory disease of the colonic mucosa, which typically starts in the rectum and extends proximally trough the entire colon. Bloody diarrhoea is the characteristic symptom of the disease of unknown cause that is characterized by alternating intervals of active and inactive disease in 80–90% patients and requiring lifelong treatment.
The primary goal of treatment of ulcerative colitis, which is sequential, is to induce and maintain remission using therapy tailored to the individual patient. A considerable proportion of patients will not respond to first-line treatment with mesalazine or steroid therapy, about a quarter of patients who respond to steroid therapy become steroid dependent.
In acute severe refractory ulcerative colitis further management involves decisions on whether to use rescue therapy in the form of ciclosporin or infliximab or to offer timely surgery. A phycician´s approach to patients with ulcerative colitis who are refractory to standard first-line therapy must be thoughtful and systematic, after exclusion other causes of non-responsibility to first-line therapy is necessary to choose the most appropriate available therapeutic options.
The evidence based for the choices for optimal management of refractory ulcerative colitis is presented.