ECCO topical review: Refractory IBD

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.


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.



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