Endoscopic diagnosis of refractory ulcerative colitis

To make the endoscopic characteristics and clinical appearance of refractory ulcerative colitis (UC) clear, we studied the frequency and location of refractory lesions of severe UC patients.

The subjects were a total of 68 patients with severe UC. 41 patients were identified with refractory UC, defined as poor response to high-dose systemic steroids (SH-resistant UC), and another group of 27 patients had non-refractory UC (SH-responsive UC). Two groups were compared by the following item; endoscopic findings, locations, effect of treatment, and relation to CMV infection.

In SH-resistant UC, longitudinal ulcer and extensive mucosal abrasion were found with high frequency, and there were refractory lesion significantly in proximal colon. In case of UC with refractory lesion, there is a high possibility that treatment is ineffective. Of 14 UC patients with refractory lesion treated with LCAP, 10 obtained remission, whereas only 12 of 30 those patients with treated by only steroids achieved remission. Of 11 steroid-refractory UC patients with CMV detected, were refractory to steroids and had undergone.

The findings of this study suggest that it is very important to decide on a patient's medication by relying on exact diagnosis concerning the condition of UC by endoscopy.