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.
