J Crohns Colitis. 2021 Jun 23;jjab112. doi: 10.1093/ecco-jcc/jjab112. Online ahead of print.

Tim Raine ¹, Bram Verstockt ², Uri Kopylov ³, Konstantinos Karmiris ⁴, Rima Goldberg ⁵, Raja Atreya ⁶, Johan Burisch ⁷, John Burke ⁸, Pierre Ellul ⁹, Charlotte Hedin ^10 11, Stefan D Holubar ¹², Konstantinos Katsanos ¹³, Triana Lobaton ¹⁴, Carsten Schmidt ¹⁵, Garret Cullen ¹⁶

Author information

• ¹Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
• ²Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium and Department of Chronic Diseases and Metabolism, TARGID - IBD, KU Leuven, Leuven, Belgium.
• ³Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
• ⁴Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece.
• ⁵Department of Gastroenterology, Monash Health; School of Clinical Sciences, Monash University, Melbourne, Australia.
• ⁶Department of Medicine 1, University of Erlangen-Nürnberg, Erlangen, Germany.
• ⁷Gastrounit, Medical Division, Hvidovre Hospital, University of Copenhagen, Denmark.
• ⁸Colorectal and General Surgery, Beaumont Hospital, Dublin, Ireland.
• ⁹Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, Msida, Malta.
• ¹⁰Karolinska Institutet, Department of Medicine Solna, Stockholm, Sweden.
• ¹¹Karolinska University Hospital, Gastroenterology unit, Department of Gastroenterology, Dermatovenereology and Rheumatology, Stockholm, Sweden.
• ¹²Department of Colon & Rectal Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
• ¹³Department of Gastroenterology and Hepatology, University and Medical School of Ioannina, Ioannina, Greece.
• ¹⁴Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium.
• ¹⁵Medical Clinic II, Department of Gastroenterology, Hepatology, Endocrinology, Diabetology and Infectious Diseases, Fulda Hospital, University Medicine Marburg, Fulda, Germany.
• ¹⁶Centre for Colorectal Disease, St Vincent's University Hospital and School of Medicine, University College Dublin, Gastroenterology, Dublin, Ireland.

Abstract

Inflammatory bowel disease is a chronic disease with variable degrees of extent, severity, and activity. A proportion of patients will have disease that is refractory to licensed therapies, resulting in significant impairment in quality-of-life. The treatment of these patients involves a systematic approach by the entire multi-disciplinary team, with particular consideration given to medical options including unlicensed therapies, surgical interventions, and dietetic and psychological support. The purpose of this review is to guide clinicians through this process and provide an accurate summary of the available evidence for different strategies.