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Management of the refractory patient
Axel Dignass recommended testing for cytomegalovirus and Clostridium difficile which are frequently found in refractory UC. IBD care is in effect sub par due to suboptimal dosing or absent topical 5-ASA-therapy. Steroids are currently the standard therapy for refractory UC. ECCO’s international guidelines propose anti-TNF therapy or tacrolimus for second line treatment although surgical options or admission for parenteral steroid therapy could also be considered. New medications in the horizon include vedolizumab and alternative anti-TNF, among others.