Refractory Inflammatory Bowel Disease.

Therapeutic options for refractory colonic inflammation in patients with ulcerative colitis or Crohn's disease have recently been expanded with the introduction of biologic therapies. Intravenous corticosteroids and cyclosporine A remain the standard therapies for severe ulcerative colitis. Monoclonal antibodies directed at tumor necrosis factor-a have proven to be exceptionally efficacious in patients with severe or refractory Crohn's disease. Immunomodulatory therapy with azathioprine, 6-mercaptopurine, or methotrexate has demonstrated efficacy for maintenance of remission in patients with refractory ulcerative colitis or Crohn's disease. The use of experimental biologic agents may be considered for those patients who fail to respond to or remain dependent on corticosteroids. Surgical intervention still remains for patients with severe colitis who fail to respond to medical therapy or develop life-threatening complications such as perforation or toxic megacolon.