Azathioprine combined with either rifaximin (A microecological inhibitor) or infliximab for inflammatory bowel disease: Differential impacts on intestinal barrier function, inflammatory response and stress injury.

BACKGROUND

Inflammatory bowel disease (IBD) is an immune-related chronic intestinal inflammatory disease. In recent years, the incidence of IBD has increased significantly and the trend of younger age is obvious.

OBJECTIVES

This prospective cohort study compared the effects of microecological inhibitors (rifaximin, RIF) plus azathioprine (AZA) versus infliximab (IFX) plus AZA in patients with active IBD.

METHODS

A total of 130 patients were randomized into two groups and treated for 12 weeks. Key outcomes included intestinal barrier function [Diamine oxidase (DAO), Fecal calprotectin (FC), Lipopolysaccharide (LPS)], mucosal repair markers [Epidermal growth factor (EGF), Transforming growth factor-β1 (TGF-β1)], inflammatory factors [Interleukin-6 (IL-6) and Tumor necrosis factor-α (TNF-α), C reactive protein (CRP)] and oxidative stress indices [Superoxide dismutase (SOD), Malondialdehyde (MDA)].

RESULTS

IFX+AZA rapidly reduced pro-inflammatory cytokines (TNF-α decreased, CRP increased) and mucosal injury markers (DAO increased), but elevated LPS levels (P<0.05). In contrast, RIF + AZA enhanced mucosal repair (EGF decreased, TGF-β1 decreased) and antioxidant capacity (SOD decreased, MDA increased), with less liver enzyme elevation. The study suggests IFX + AZA is superior for acute inflammation control via TNF-α inhibition, while RIF + AZA offers long-term benefits in mucosal healing and oxidative balance through microbiota modulation.

CONCLUSION

IFX + AZA for rapid induction remission and RIF+AZA for maintenance therapy in IBD.