REVIEW ARTICLE - REFRACTORY DISTAL COLITIS-EXPLANATIONS AND OPTIONS

Distal colitis refractory to standard therapy is a complex and challen ging problem. Physiological differences between the right and left col on may be exploited for maximum therapeutic benefit, Over-reliance on oral therapy should be seen as one of the reasons for treatment failur e and delivery systems should target therapy to the distribution of th e disease in doses proven to be therapeutically beneficial, The clinic ian should also be cognizant of potential adverse effects of standard therapies, particularly colitis due to mesalazine, which may mimic wor sening disease. Numerous endogenous and exogenous factors that may exa cerbate the underlying inflammatory bowel disease are discussed, This review explores the potential mechanisms why distal colitis may be ref ractory to therapy and addresses newer therapies that, while still in the investigatory stages, offer hope for a widening armamentarium of t herapeutic modalities.