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4 Maintenance of remission7 82 84 90 93 103 105 157 168 265 Long-term maintenance therapy is generally recommended for all patients, especially those with left-sided or extensive disease, and those with proctitis who relapse more than once a year. Discontinuation of medication may be reasonable for those with distal disease who have been in remission for 2 years and are averse to such medication. The role of anti-TNF is discussed earlier and NICE does not approve use. Recommendations for the maintenance of remission in ulcerative colitis: < Patients with ulcerative colitis should normally receive maintenance therapy with aminosalicylates, azathioprine, or mercaptopurine to reduce the risk of relapse.

Infants of mothers taking higher doses may theoretically have a degree of adrenal suppression but the benefits of breast feeding are likely to outweigh the risks. A 4-h delay following oral exposure has been suggested to minimise exposure. Budesonide (FDA C) No studies have been performed in patients with IBD but the theoretical risks are those in the section above. The use of inhaled budesonide would suggest that the drug is safe in pregnancy and breast feeding. Thiopurines (FDA D) Although the manufacturers of AZA and MP advise avoiding in pregnancy there are considerable data, most of which come from the transplant and rheumatology literature, showing no alterations in fertility, pre-term delivery, or congenital defects.

Hand-sewn or stapled pouch 3. pouch configuration (W, S, J) 4. 285e290 Many of the choices rely on surgical judgement and surgical expertise. 3 complications and functional outcome Sub-total colectomy As a result of the severity of illness complications post surgery are significant. Failure of healing and sepsis being common especially with patients on high does corticosteroids. 300e302 This is further evidence for co-operative management of these patients by senior gastroenterologists and surgeons.

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