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Related Concept Videos

Inflammatory Bowel Disease II: Ulcerative Colitis01:20

Inflammatory Bowel Disease II: Ulcerative Colitis

Ulcerative colitis is a chronic inflammatory disorder of the colon characterized by continuous mucosal inflammation that typically begins in the rectum and extends proximally in a uniform pattern. Its pathogenesis involves a complex interplay of genetic predisposition, immune dysregulation, and environmental influences. These factors converge to impair the colon’s epithelial defenses and promote an exaggerated inflammatory response against luminal contents.Breakdown of the Mucosal BarrierA...
Inflammatory Bowel Disease I: Ulcerative Colitis01:27

Inflammatory Bowel Disease I: Ulcerative Colitis

Introduction
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
Inflammatory Bowel Disease I: Introduction01:26

Inflammatory Bowel Disease I: Introduction

Inflammatory bowel disease is a group of chronic disorders marked by recurrent inflammation of the gastrointestinal tract due to an abnormal immune response against gut microflora. This leads to tissue damage. The two main forms are Crohn’s disease and ulcerative colitis.Crohn’s DiseaseCrohn’s disease is a relapsing inflammatory disorder that can affect any part of the GI tract, from the mouth to the anus. It involves all layers of the bowel wall (transmural) and shows “skip lesions” in which...
Inflammatory Bowel Disease IV: Clinical Manifestations01:20

Inflammatory Bowel Disease IV: Clinical Manifestations

Inflammatory bowel disease (IBD) encompasses two major chronic disorders—ulcerative colitis and Crohn’s disease—each characterized by relapsing episodes of gastrointestinal inflammation. Although they share certain clinical features, their patterns of involvement and manifestations differ in ways that aid diagnosis and guide management.Ulcerative ColitisUlcerative colitis is limited to the colon and rectum and involves continuous inflammation of the mucosal layer. The disease course is marked...
Chronic Bowel Disorders: Introduction01:17

Chronic Bowel Disorders: Introduction

Chronic bowel diseases are a group of long-term conditions affecting the digestive tract, characterized by inflammation and damage to the gut lining. These conditions primarily include irritable bowel syndrome and inflammatory bowel disease.
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...
Inflammatory Bowel Disease II: Crohn's Disease01:30

Inflammatory Bowel Disease II: Crohn's Disease

Introduction
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
Crohn's disease is a chronic, systemic inflammatory bowel disease (IBD) that predominantly affects the gastrointestinal tract. It is marked by transmural...

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Murine Distal Colostomy, A Novel Model of Diversion Colitis in C57BL/6 Mice
08:20

Murine Distal Colostomy, A Novel Model of Diversion Colitis in C57BL/6 Mice

Published on: July 12, 2018

Fulminant colitis.

Bruce E Sands1

  • 1MGH Crohn's and Colitis Center and Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St., 9th Floor, Boston, MA 02114, USA. bsands@partners.org

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
|September 4, 2008
PubMed
Summary
This summary is machine-generated.

Fulminant colitis management remains challenging, with corticosteroids reducing but not eliminating mortality. Early intervention with therapies like cyclosporine or infliximab is crucial to prevent colectomy and improve outcomes.

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Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Clinical Medicine

Background:

  • Fulminant colitis presents a significant clinical challenge, with a persistent 2% case fatality rate despite advances in management.
  • Corticosteroids have historically reduced mortality and colectomy rates, but further therapeutic strategies are needed.

Purpose of the Study:

  • To review current medical therapies for fulminant colitis, including corticosteroids, cyclosporine, and infliximab.
  • To discuss the role of these agents in preventing colectomy and optimizing surgical outcomes when colectomy is unavoidable.

Main Methods:

  • Review of existing literature on the medical management of severe and fulminant colitis.
  • Analysis of treatment strategies involving corticosteroids, cyclosporine, and infliximab as rescue and maintenance therapies.

Main Results:

  • Cyclosporine rescue therapy requires thiopurine maintenance for durable remission; infliximab can be maintained with itself or a thiopurine.
  • Both cyclosporine and infliximab carry risks, including neurotoxicity and opportunistic infections, necessitating careful patient selection and monitoring.

Conclusions:

  • Judicious timing of colectomy is critical, as prolonged unsuccessful medical therapy increases mortality.
  • Optimizing medical management and surgical timing are essential for improving outcomes in fulminant colitis.