Letters To The Editor
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Sep 7, 2009; 15(33): 4218-4219
Published online Sep 7, 2009. doi: 10.3748/wjg.15.4218
Early aggressive therapy for severe extensive ulcerative colitis
De-Jun Cui
De-Jun Cui, Department of Gastroenterology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Cui DJ wrote the entire commentary.
Correspondence to: De-Jun Cui, PhD, Department of Gastroenterology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, Sichuan Province, China. hxcuidj@hotmail.com
Telephone: +86-851-5369270 Fax: +86-851-7988383
Received: June 28, 2009
Revised: July 23, 2009
Accepted: July 30, 2009
Published online: September 7, 2009

The current ulcerative colitis (UC) treatment algorithm involves a step-up therapeutic strategy, mainly aiming at inducing and maintaining its clinical remission. Although this therapeutic strategy may seem to be cost-efficient and reduce the risk of side effects, recent trials and case reports have shown that top-down therapy using infliximab induces a rapid clinical response, enhances patient quality of life, promotes mucosal healing, reduces surgeries and indirect cost of treatment for patients with severe UC. Moreover, since long-term treatment with infliximab is safe and well tolerated, early aggressive top-down therapeutic strategy may be a more effective approach, at least in a subgroup of severe extensive UC patients.

Keywords: Infliximab, Ulcerative colitis, Top-down therapy