AIM: To determine if infliximab can prevent or delay surgery in refractory ulcerative colitis (UC).METHODS: UC patients who failed to have their disease controlled with conventional therapies and were to undergo colectomy if infliximab failed to induce a clinical improvement were reviewed.Patients were primarily treated with a single 5 mg/kg infliximab dose.The Colitis Activity Index (CAI) was used to determine response and remission.Data of 8 wk response and colectomy rates at 6 mo and 12 mo were collected.RESULTS: Fifteen patients were included, 7 with UC unresponsive or intolerant to IV hydrocortisone, and 8 with active disease despite oral steroids (all but one with therapeutic dosage and duration of immunomodulation).All the Ⅳ hydrocortisone-resistant/intolerant patients had been on azathioprine/6-MP < 8 wk.At 8 wk, infliximab induced a response in 86.7% (13/15) with 40% in remission (6/15).Within 6 mo of treatment 26.7% (4/15)had undergone colectomy and surgery was avoided in 46.6% (7/15) at 12 mo.The colectomy rate at 12 mo in those on immunomodulatory therapy < 8 wk at time of infliximab was 12.5% (1/8) compared with 100%(7/7) in patients who were on long-term maintenance immunomodulators (P < 0.02).CONCLUSION: Infliximab prevented colectomy due to active disease in immunomodulatory-naive, refractory UC patients comparable to the use of Cyclosporine.In patients, however, on effective dosage and duration of immunomodulation at time of infliximab therapy colectomy was not avoided.