Refractory symptoms may be treated with azathioprine or infliximab. Patients who do not respond to treatment with oral corticosteroids require hospitalization and intravenous steroids. The side effects of steroids limit their usefulness for chronic therapy. More extensive disease requires treatment with oral 5-aminosalicylic acid compounds and oral corticosteroids. Rectal therapy with 5-aminosalicylic acid compounds is used for proctitis. Treatment is based on the extent and severity of the disease. Tests such as perinuclear antineutrophilic cytoplasmic antibodies and anti- Saccharomyces cerevisiae antibodies are promising, but not yet recommended for routine use. As many as 25 percent of patients with ulcerative colitis have extraintestinal manifestations. Ulcerative colitis is a chronic disease with recurrent symptoms and significant morbidity.
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