The management of refractory severe inflammatory bowel disease (IBD) is still unresolved. We read with interest the article by Stallmach et al on the safety and efficacy of intravenous pulse cyclophosphamide in acute steroid refractory IBD (Gut 2003;52:377–82).

In common with other disease, the aims of therapy in IBD fall into three categories:

1. induction of remission;

2. maintenance of remission; and

3. prevention of relapse, all of which should be undertaken with minimal mortality and morbidity …