Sylvestre PB. Reducing agents for induction and maintenance therapy achieve long-term remission of refractory ulcerative colitis: A case report and review of literature. World J Gastroenterol 2026; 32(2): 114222 [DOI: 10.3748/wjg.v32.i2.114222]
Corresponding Author of This Article
Pamela B Sylvestre, MD, Professor, Pathology and Laboratory Medicine, Cincinnati Children’s Hospital Medical Center, 240 Albert Sabin Way, MLC1035, Cincinnati, OH 45229, United States. sylvespa@ucmail.uc.edu
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Gastroenterology & Hepatology
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Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jan 14, 2026 (publication date) through Jan 13, 2026
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World Journal of Gastroenterology
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1007-9327
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Sylvestre PB. Reducing agents for induction and maintenance therapy achieve long-term remission of refractory ulcerative colitis: A case report and review of literature. World J Gastroenterol 2026; 32(2): 114222 [DOI: 10.3748/wjg.v32.i2.114222]
World J Gastroenterol. Jan 14, 2026; 32(2): 114222 Published online Jan 14, 2026. doi: 10.3748/wjg.v32.i2.114222
Reducing agents for induction and maintenance therapy achieve long-term remission of refractory ulcerative colitis: A case report and review of literature
Pamela B Sylvestre
Pamela B Sylvestre, Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45229, United States
Pamela B Sylvestre, Pathology and Laboratory Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, United States
Author contributions: Sylvestre PB confirms accountability for all aspects of this work and has approved it for publication; and responsibilities included drafting and critical revision of the manuscript, photography of pathology slides, and final approval of the version to be published.
Informed consent statement: Informed written consent has been obtained from the patient for publication of this report.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pamela B Sylvestre, MD, Professor, Pathology and Laboratory Medicine, Cincinnati Children’s Hospital Medical Center, 240 Albert Sabin Way, MLC1035, Cincinnati, OH 45229, United States. sylvespa@ucmail.uc.edu
Received: September 16, 2025 Revised: November 13, 2025 Accepted: December 3, 2025 Published online: January 14, 2026 Processing time: 119 Days and 12.8 Hours
Abstract
BACKGROUND
Ulcerative colitis (UC) is a chronic and debilitating inflammatory bowel disease. Cumulative evidence indicates that excess hydrogen peroxide, a potent neutrophilic chemotactic agent, produced by colonic epithelial cells has a causal role leading to infiltration of neutrophils into the colonic mucosa and subsequent development of UC. This evidence-based mechanism identifies hydrogen peroxide as a therapeutic target for reducing agents in the treatment of UC.
CASE SUMMARY
Presented is a 41-year-old female with a 26-year history of refractory UC. Having developed steroid dependence and never achieving complete remission on treatment by conventional and advanced therapies, she began treatment with oral R-dihydrolipoic acid (RDLA), a lipid-soluble reducing agent with intracellular site of action. Within a week, rectal bleeding ceased. She was asymptomatic for three years until a highly stressful experience, when she noticed blood in her stool. RDLA was discontinued, and she began treatment with oral sodium thiosulfate pentahydrate (STS), a reducing agent with extracellular site of action. After a week, rectal bleeding ceased, and she resumed oral RDLA and discontinued STS. To date, she remains asymptomatic with normal stool calprotectin while on RDLA.
CONCLUSION
STS and RDLA are reducing agents that serve as highly effective and safe therapy for the induction and maintenance of remission in UC, even in patients refractory or poorly controlled by conventional and advanced therapies. Should preliminary findings be validated by subsequent clinical trials, the use of reducing agents could potentially prevent thousands of colectomies and represent a paradigm shift in the treatment of UC.
Core Tip: Reducing agents, sodium thiosulfate and R-dihydrolipoic acid, are safe and highly effective to induce and maintain remission of ulcerative colitis, respectively, without the need for immunosuppressive drugs, even in patients who are refractory or poorly controlled by conventional and advanced therapies.
