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Related Concept Videos

Inflammatory Bowel Disease V: Surgical Management01:21

Inflammatory Bowel Disease V: Surgical Management

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Surgical interventions for inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease, are essential in managing symptoms and addressing complications. The selection of surgical procedures is contingent upon the specific conditions and complications that stem from these illnesses.
Here are some common surgical interventions for IBD:
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Inflammatory Bowel Disease IV: Pharmacological Management01:29

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Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
Pharmacologic...
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Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
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Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF01:24

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Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab...
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Ulcerative colitis is a chronic inflammatory condition primarily affecting the colon and rectum. The primary drugs used in the treatment of ulcerative colitis are aminosalicylates. They exhibit anti-inflammatory and immunosuppressive properties. They modulate inflammatory mediators and inhibit the activity of nuclear factor κB (NF-κB). Aminosalicylates also reduce inflammation by inhibiting prostaglandin and leukotriene production and decreasing neutrophil chemotaxis and superoxide...
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Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
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[Pouchitis showed complete response to ustekinumab].

Yukako Nemoto1,2, Shinya Tajima2, Kota Saito2

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Ustekinumab (UST) effectively treated refractory pouchitis in a ulcerative colitis patient who previously failed steroid therapy. This biological therapy achieved long-term remission, resolving severe symptoms and inflammation.

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Area of Science:

  • Gastroenterology
  • Immunology
  • Surgical Gastroenterology

Background:

  • Pouchitis is a common complication after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis.
  • Refractory pouchitis poses treatment challenges, often requiring prolonged steroid use with significant side effects.
  • Biological therapies show promise for inflammatory bowel disease, including refractory pouchitis.

Observation:

  • A 64-year-old female with a history of ulcerative pancolitis and steroid-dependent pouchitis post-IPAA presented with severe symptoms.
  • Despite steroid tapering and thiopurine initiation, the patient experienced worsening inflammation, elevated ESR, and arthritis.
  • The patient received ustekinumab (UST) for refractory pouchitis and associated arthritis.

Findings:

  • Ustekinumab treatment led to a significant reduction in stool frequency and resolution of bloody diarrhea.
  • Pouchoscopy confirmed healing of the afferent limb and ileitis within 14 months of UST optimization.
  • The patient achieved sustained pouchitis remission for over 2 years, with resolution of arthritis and cessation of NSAIDs.

Implications:

  • Ustekinumab is a viable and effective therapeutic option for patients with refractory pouchitis.
  • Biological therapy can offer long-term remission and improved quality of life in complex pouchitis cases.
  • This case highlights the potential of ustekinumab in managing severe, treatment-resistant pouchitis and associated extraintestinal manifestations.