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Up to 18% of patients suffer chronic active disease, with 30% requiring colectomy at 10\u00a0years. The management remains challenging given the relatively few clinical trials in this area.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To summarise the evidence regarding optimal management strategies for patients with chronic active <jats:styled-content style=\"fixed-case\">UC<\/jats:styled-content> of differing disease extents and degrees of treatment refractoriness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>A literature search using the PubMed and Medline databases was performed. No time limit was set on article publication for inclusion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The principles of management should focus on confirming disease activity, exclusion of alternative diagnoses, adherence and treatment escalation. Infliximab and topical tacrolimus are options in refractory proctitis, although the evidence for these therapies is limited. Both infliximab and adalimumab are effective in corticosteroid\u2010refractory disease, although the proportions of patients achieving corticosteroid\u2010free remission remain modest (24% at 30\u00a0weeks and 16.9% at 8\u00a0weeks respectively). Alternatives include ciclosporin and tacrolimus, and possibly methotrexate. Colectomy often leads to an improved quality of life; medical strategies unlikely to provide durable corticosteroid\u2010free remission should not be pursued.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>No current pharmacological treatment delivers mucosal healing in the majority of patients. Newer treatments such as vedolizumab and tofacitinib may represent valuable future therapies. Available medical options should be discussed with patients at every step of their management, with an honest appraisal of the evidence. Surgery should always be considered in patients with chronic refractory disease of any extent.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.12345","type":"journal-article","created":{"date-parts":[[2013,5,30]],"date-time":"2013-05-30T01:47:26Z","timestamp":1369878446000},"page":"77-97","source":"Crossref","is-referenced-by-count":35,"title":["Review article: strategies for the management of chronic unremitting ulcerative colitis"],"prefix":"10.1111","volume":"38","author":[{"given":"S. J.","family":"Mehta","sequence":"first","affiliation":[{"name":"Centre for Digestive Diseases Blizard Institute Barts and the London School of Medicine Queen Mary University London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. 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