Cytapheresis as a Nonpharmacological Therapy for Inflammatory Bowel Disease

Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), is a chronic recurrent disease with unknown etiology; however, recent studies suggest that impaired immune responses to intestinal tissue and/or intestinal flora play important roles in the pathogenesis of IBD. For patients with IBD, 5-aminosalycilates are often used in case of mild disease and corticosteroids are mainly used for moderate to severe disease. However, we often encounter patients who are resistant to or dependent on conventional therapy, which is likely to lead to future problems concerning the quality of life due to adverse effects of the drugs used, especially the corticosteroids. Extracorporeal leukocyte removal therapy (cytapheresis) is one of the adjunctive therapies for IBD patients refractory to steroids, through suppression of the impaired immune response by removing activated leukocytes from the circulating blood system, especially granulocytes and lymphocytes. The present paper reviews the latest evidences in order to propose the current status of cytapheresis in the therapeutic strategy for IBD, especially for UC and CD. Although there are a few randomized controlled trials, clinical experience so far suggests that cytapheresis has superior efficiency as a nonpharmacological immunomodulative therapy for steroidresistant moderate to severe UC. Moreover, cytapheresis is characterized by higher safety compared with other conventional medications for severe UC.