Management of Refractory and Difficult‐To‐Treat Inflammatory Bowel Disease: An Expert Opinion Review
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Le résumé fourni par la source
ABSTRACT The management of refractory and difficult‐to‐treat inflammatory bowel disease (IBD) poses significant challenges, requiring a personalized, treat‐to‐target approach. Refractory IBD is defined as persistent or worsening disease despite all classes of licensed immunosuppressive and biologic agents, with additional criteria for Crohn's disease (CD) and ulcerative colitis (UC). Because studies restricted to strictly patients refractory are scarce for several treatment modalities, evidence from difficult‐to‐treat populations is also considered here. A multidisciplinary evaluation, including adherence, dose optimization, disease phenotype, smoking cessation, genetic factors, and exclusion of mimicking conditions, is essential before introducing unlicensed therapies. Comprehensive strategies encompass screening, combination therapy, surgical interventions, and nutritional support. Emerging therapies focus on targeting inflammation and immune pathways, including Janus kinase (JAK) inhibitors (e.g., tofacitinib and upadacitinib), IL‐23 antagonists (e.g., risankizumab), and TL1A inhibitors (e.g., PF‐06480605). Novel approaches, such as mesenchymal stem cell therapy and hyperbaric oxygen therapy, have been reported mainly in perianal fistulizing CD, although the supporting evidence remains limited. Nutritional therapies, especially exclusive enteral nutrition, are effective in managing pediatric CD, whereas partial enteral nutrition may provide long‐term benefits. Future strategies may incorporate combination or sequential therapies during induction and maintenance phases to optimize outcomes. Despite these advancements, significant unmet needs persist, emphasizing the necessity for personalized, evidence‐based interventions. Here, we tried to outline current insights, diagnostic considerations, and therapeutic innovations, providing a comprehensive resource for improving the management of refractory IBD. For several of these questions, the evidence is limited to case series, so the statements have not been graded, and expert opinion is identified as such in the text.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Management of Refractory and Difficult‐To‐Treat Inflammatory Bowel Disease: An Expert Opinion Review
- Date Crossref
- 01/09/2026
- Éditeur
- Wiley
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Istanbul University Department of Internal Medicine pays non établi dans la noticeUniversité ou école supérieure
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Istanbul University-Cerrahpaşa pays non établi dans la noticeUniversité ou école supérieure
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Ege University Department of Internal Medicine pays non établi dans la noticeUniversité ou école supérieure
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TOBB University of Economics and Technology pays non établi dans la noticeUniversité ou école supérieure
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Hacettepe University Department of Internal Medicine pays non établi dans la noticeUniversité ou école supérieure
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Ankara University Department of Internal Medicine pays non établi dans la noticeUniversité ou école supérieure
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Dokuz Eylül University Department of Internal Medicine pays non établi dans la noticeUniversité ou école supérieure
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Trakya University Department of Internal Medicine pays non établi dans la noticeUniversité ou école supérieure
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Department of Gastroenterology TOBB ETU Medical Faculty Ankara Turkey pays non établi dans la noticeUniversité ou école supérieure
Department of Internal Medicine — Istanbul University, Istanbul University-Cerrahpaşa et Department of Internal Medicine — Ege University, avec 6 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.