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Clin Colon Rectal Surg 2022; 35(01): 032-043
DOI: 10.1055/s-0041-1740036
Review Article

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

Aderson Omar Mourão Cintra Damião
1   Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
,
Natália Sousa Freitas Queiroz
1   Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
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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

ulcerative colitis - colectomy - biologics - tofacitinib


Publication History

Article published online:
17 January 2022

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