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Inflammatory Bowel Disease I: Ulcerative Colitis01:27

Inflammatory Bowel Disease I: Ulcerative Colitis

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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...
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Drugs for Treatment of Ulcerative Colitis in IBD01:29

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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 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 II: Crohn's Disease01:30

Inflammatory Bowel Disease II: Crohn's Disease

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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...
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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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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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Clostridioides difficile Infection Is Associated With Increased Colectomy Risk in Acute Severe Ulcerative Colitis

Tamara F Kahan1, Olivia Delau1, Simon Hong1

  • 1Division of Gastroenterology.

Journal of Clinical Gastroenterology
|November 7, 2025
PubMed
Summary

Colectomy is common in acute severe ulcerative colitis (ASUC) despite infliximab (IFX) treatment. Clostridioides difficile infection and a high CRP/albumin ratio predict colectomy risk within one year, aiding early intervention strategies.

Keywords:
colectomyinfliximabulcerative colitis

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Area of Science:

  • Gastroenterology
  • Immunology
  • Clinical Medicine

Background:

  • Infliximab (IFX) is a key treatment for acute severe ulcerative colitis (ASUC).
  • A significant proportion of ASUC patients (up to 30%) still require colectomy within one year of IFX treatment.
  • Limited clinical data exists for ASUC patients undergoing colectomy post-IFX.

Purpose of the Study:

  • To identify risk factors for colectomy in ASUC patients receiving in-hospital IFX.
  • To analyze demographic, clinical, and laboratory predictors of colectomy within 30 days and 1 year.

Main Methods:

  • Retrospective analysis of ASUC patients treated with IFX between 2014-2022.
  • Utilized Cox proportional hazards models to assess risk factors.
  • Evaluated colectomy rates within 30 days and 1 year of IFX initiation.

Main Results:

  • 21.2% of patients (36/170) underwent colectomy within 1 year; 12.9% (22/170) within 30 days.
  • Clostridioides difficile infection during admission, reduced C-reactive protein (CRP) response, and frequent bowel movements predicted 1-year colectomy on univariable analysis.
  • Multivariable analysis identified C. difficile infection (aHR=2.92) and higher admission CRP/albumin ratio (aHR=1.13) as significant predictors of 1-year colectomy.

Conclusions:

  • Clostridioides difficile infection and elevated CRP/albumin ratio on admission are associated with increased colectomy risk within one year for ASUC patients on IFX.
  • These findings can help stratify patients for timely interventions, including JAK-inhibitor therapy or surgical consultation.
  • Early identification of high-risk patients may optimize treatment pathways and reduce colectomy delays.