In patients with severe medically refractory IBDU, should infliximab be considered before colectomy with IPAA, and what is the potential benefit beyond disease control

What is known

- In a cohort of 20 patients with severe refractory indeterminate colitis, 70% had a complete response to infliximab and the 4 non-responders underwent colectomy with IPAA. ¹ - Half the patients were reclassified as Crohn's disease during follow-up; infliximab efficacy was similar in reclassified and still-indeterminate patients. ¹ - Indeterminate colitis patients have more pelvic sepsis, pouch fistula, and pouch failure after IPAA than ulcerative colitis patients, making pre-surgical diagnostic clarification relevant. ^1,2

What is unknown / caveats

- Evidence rests on a single small (n=20) retrospective cohort - No controlled comparison of surgery-first versus infliximab-then-surgery - Whether infliximab exposure before colectomy affects postoperative surgical morbidity is not resolved in the provided excerpts.

## References

1. Papadakis KA, Treyzon L, Abreu MT, Fleshner PR, Targan SR, Vasiliauskas EA. Infliximab in the treatment of medically refractory indeterminate colitis. Aliment Pharmacol Ther. 2003;18(7):741-7. PMID: 14510748.

2. Tremaine WJ. Is indeterminate colitis determinable?. Curr Gastroenterol Rep. 2012;14(2):162-5. PMID: 22314810.

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_Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._