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Review
. 2022 Jan 17;35(1):32-43.
doi: 10.1055/s-0041-1740036. eCollection 2022 Jan.

Medical Therapy in Chronic Refractory Ulcerative Colitis: When Enough Is Enough

Aderson Omar Mourão Cintra Damião  1 , Natália Sousa Freitas Queiroz  1
Affiliations
Review

Medical Therapy in Chronic Refractory Ulcerative Colitis: When Enough Is Enough

Aderson Omar Mourão Cintra Damião et al. Clin Colon Rectal Surg. .

Abstract

Despite significant improvements in the management of ulcerative colitis (UC) in parallel with the evolution of therapeutic targets and novel biologics and small molecules, a subset of medically refractory patients still requires colectomy. Recent population-based studies demonstrate a trend toward a decrease in the rates of surgery for UC patients in the biological era, although the potential of disease modification with these agents is still debated. As the concept of irreversible bowel damage is underexplored in UC, refractory patients can be exposed to multiple treatments losing optimal timing for surgery and further developing complications such as dysplasia/cancer, dysmotility, microcolon, and other functional abnormalities. This review aims to discuss the concept of disease progression in UC, explore the limitations of medical treatment in refractory UC patients, and propose the application of a three-step algorithm that allows timely indication for surgery in clinical practice.

Keywords: biologics; colectomy; tofacitinib; ulcerative colitis.

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Conflict of interest statement

Conflict of Interest N.S.F.Q. reports receiving consulting and lecture fees from Janssen, Takeda, and Abbvie. A.O.M.C.D. reports receiving fees as speaker for Janssen, Abbvie, Pfizer, Takeda; Consulting fees from Ferring, Janssen; Member of Advisory Board of Takeda.

Figures

Fig. 1
Fig. 1
The three-step suggested algorithm for the management of refractory ulcerative colitis (UC) in the outpatient setting. anti-TNF, tumor necrosis factor antibody; C.diff, Clostridioides difficile ; CMV, Cytomegalovirus ; CRP, C-reactive protein; IMM, immunomodulators; MES, Mayo endoscopic subscore; STRIDE, selecting therapeutic targets in inflammatory bowel disease program ; TOFA, tofacitinib; UST, ustekinumab; VEDO, vedolizumab; for low and high risk factors for colectomy see text and Table 1 .
See this image and copyright information in PMC

References

    1. Cosnes J, Gower-Rousseau C, Seksik P, Cortot A. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology. 2011;140(06):1785–1794. - PubMed
    1. Allen P B, Gower-Rousseau C, Danese S, Peyrin-Biroulet L. Preventing disability in inflammatory bowel disease. Therap Adv Gastroenterol. 2017;10(11):865–876. - PMC - PubMed
    1. Rutgeerts P, Sandborn W J, Feagan B G. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med. 2005;353(23):2462–2476. - PubMed
    1. Lopez A, Ford A C, Colombel J-F, Reinisch W, Sandborn W J, Peyrin-Biroulet L. Efficacy of tumour necrosis factor antagonists on remission, colectomy and hospitalisations in ulcerative colitis: meta-analysis of placebo-controlled trials. Dig Liver Dis. 2015;47(05):356–364. - PubMed
    1. AGA Institute Clinical Guidelines Committee . Feuerstein J D, Isaacs K L, Schneider Y, Siddique S M, Falck-Ytter Y, Singh S. AGA clinical practice guidelines on the management of moderate to severe ulcerative colitis. Gastroenterology. 2020;158(05):1450–1461. - PMC - PubMed