Almogy et al listed criteria for identifying a patient with ulcerative colitis (UC) who is refractory to medical therapy. A patient who is refractory to medical therapy may be a candidate for surgery or a novel therapy. The authors are from Mount Sinai Medical School in New York City.


A patient with ulcerative colitis is considered refractory to medical therapy if:

(1) the patient has persistent, severe morbidity, which may include:

(1a) diarrhea

(1b) abdominal pain

(1c) gastrointestinal bleeding

(1d) weight loss or malnutrition

(2) the patient is receiving maximal medical therapy


Factors impacting maximal medical therapy:

(1) The patient is adherent to the regimen.

(2) The patient may be experiencing unacceptable side effects, including those associated with steroid dependency.

(3) The regimen has been reviewed by a physician who has expertise in treating ulcerative colitis.

(4) The occurrence of a rebound in symptoms when trying to reduce medications.

(5) All reasonable alternatives have been considered.


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