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Inflammatory Bowel Disease V: Surgical Management01:21

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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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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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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.
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The management of chronic pancreatitis is multifaceted, involving a comprehensive approach that includes thorough assessment, diagnostic testing, and a variety of management strategies.
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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.
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Various diagnostic tests are employed in the diagnostic process for Inflammatory Bowel Disease (IBD), particularly to differentiate between Crohn's disease and ulcerative colitis.
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Updated: Sep 10, 2025

Author Spotlight: Developing a Rat Model for Pouchitis Research and Treatment
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Long-Term Outcomes of First-Line Anti-TNF Therapy for Chronic Inflammatory Pouch Conditions: A Multi-Centre

Itai Ghersin1, Maya Fischman2, Giacomo Calini3,4

  • 1Department of Gastroenterology, St Mark's National Bowel Hospital & Academic Institute, London NW10 7NS, UK.

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Summary

First-line anti-tumour necrosis factor (anti-TNF) therapy shows low long-term persistence for chronic pouch conditions, often due to lack of efficacy or adverse events. Many patients experience pouch failure, necessitating alternative treatments.

Keywords:
adalimumabinfliximabpouchitisproctocolectomyrestorativetumour necrosis factor inhibitors

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Area of Science:

  • Gastroenterology
  • Immunology
  • Pharmacology

Background:

  • Anti-tumour necrosis factor (anti-TNF) agents were commonly first-line for chronic inflammatory pouch conditions.
  • Previous evidence was limited to small, short-term retrospective studies.
  • Long-term outcomes in a large, multi-centre cohort were needed.

Purpose of the Study:

  • To evaluate the long-term outcomes of first-line anti-TNF therapy in chronic inflammatory pouch conditions.
  • To assess treatment persistence and pouch failure rates.
  • To identify reasons for anti-TNF discontinuation.

Main Methods:

  • Observational, retrospective, multi-centre, multi-national study.
  • Included 98 patients with chronic inflammatory pouch conditions treated with infliximab (IFX) or adalimumab (ADA).
  • Follow-up of at least 1 year, assessing treatment persistence and pouch failure (need for ileostomy or pouch excision).

Main Results:

  • Only 22.4% of patients remained on anti-TNF therapy long-term (average follow-up 94.2 months).
  • Median time to discontinuation was 12.2 months, primarily due to lack of efficacy (30.6%) or loss of response (18.4%).
  • 34.7% of the cohort experienced pouch failure, and 42.8% switched to different medical therapies.

Conclusions:

  • First-line anti-TNF therapy has low long-term persistence in chronic pouch inflammatory conditions.
  • Lack of efficacy and adverse events are key reasons for treatment failure.
  • A significant proportion of patients develop pouch failure, highlighting the need for alternative strategies.