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Related Concept Videos

Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents01:29

Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents

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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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Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids01:21

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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

Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF

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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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Drugs for Treatment of Ulcerative Colitis in IBD01:29

Drugs for Treatment of Ulcerative Colitis in IBD

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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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Inflammatory Bowel Disease IV: Pharmacological Management01:29

Inflammatory Bowel Disease IV: Pharmacological Management

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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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Drugs for Treatment of Constipation-Predominant IBS01:21

Drugs for Treatment of Constipation-Predominant IBS

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Pharmacological therapies for IBS-C are designed to alleviate abdominal discomfort and enhance bowel function. In patients with IBS-C, fiber supplements may help soften stools and decrease straining, but may also lead to increased gas production and bloating. Osmotic laxatives like milk of magnesia are frequently used to soften stools and increase stool frequency in IBS-C patients. In addition, two drugs approved for use in severe IBS-C adult cases are linaclotide (Linzess) and lubiprostone...
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Related Experiment Video

Updated: Jun 23, 2025

Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS
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Sirolimus Use in Refractory Crohn's Disease.

Rex K Siu1, Christian Karime1, Jana G Hashash2

  • 1Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, FL.

ACG Case Reports Journal
|June 17, 2024
PubMed
Summary

Sirolimus shows potential benefits for refractory Crohn's disease (CD) in adults, but adverse effects frequently lead to treatment discontinuation. Further research is needed to optimize its use in managing this chronic inflammatory condition.

Keywords:
Crohn's diseaseadverse effectsextremity edemaimmunomodulatorinflammatory bowel diseasepoor wound healingsirolimus

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Area of Science:

  • Gastroenterology
  • Immunology
  • Pharmacology

Background:

  • Inflammatory bowel disease (IBD) management faces challenges with medication-refractory cases.
  • Pediatric studies suggest sirolimus efficacy in refractory Crohn's disease (CD).
  • Limited data exist on sirolimus use in adult refractory CD patients.

Observation:

  • This study retrospectively analyzed clinical outcomes of 4 adult patients with refractory CD treated with sirolimus.
  • Patients received sirolimus for a median duration of 524 days.
  • Some therapeutic benefits were observed during treatment.

Findings:

  • All 4 adult patients discontinued sirolimus therapy.
  • Treatment discontinuation was primarily due to adverse effects.
  • Observed benefits were outweighed by treatment-derived adverse events.

Implications:

  • Sirolimus may offer clinical utility in select adult refractory CD cases.
  • Treatment-derived adverse effects may limit the long-term role of sirolimus in CD management.
  • Further investigation is warranted to balance efficacy and tolerability for sirolimus in adult IBD treatment.