| Theme |
How Do You Choose Treatment Strategies for IBD Patients with a Critical Situation? |
| Title |
The Strategy for the Treatment of Steroid—refractory Ulcerative Colitis |
| Author |
Makoto Ooi |
Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine |
| Author |
Namiko Hoshi |
Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine |
| [ Summary ] |
Steroid‒refractory ulcerative colitis (UC), which is nonresponsive to treatment with sufficient amount of corticosteroids, is a clinically challenging condition. To avoid colectomy, anti‒TNF antibody, tacrolimus, and leukocytapheresis are available for the treatment of steroidrefractory UC. Anti‒TNF antibody (infliximab, adalimumab) is highly effective and could be used as a first‒choice treatment. Tacrolimus is also effective but only for a short period, and switching to thioprines is required to sustain long-term remission. Fluminant UC and thiopurine‒naive cases are good indications for tacrolimus administration. Leukocytapheresis has some effect on steroid‒refractory UC. However, it should not be used as a monotherapy but in combination with other medications and strategies, especially for severe or fulminant cases. |