Ischemic colitis associated with glucagon-like peptide-1 (GLP-1) receptor agonists is an exceptionally rare condition, with only a few cases reported in the literature. We present the case of a 46-year-old woman treated with oral semaglutide (Rybelsus®) for weight loss who experienced three episodes of abdominal pain and hematochezia temporally associated with drug exposure. The third episode, which occurred after semaglutide was reintroduced, led to a confirmed diagnosis based on computed tomography, rectosigmoidoscopy, and histopathological findings consistent with ischemic colitis. Permanent discontinuation of semaglutide was followed by complete clinical resolution without further recurrence. The temporal relationship, improvement after drug withdrawal, and recurrence upon rechallenge support a probable causal association. This case highlights the need to consider ischemic colitis as a potential rare adverse effect of semaglutide.

The colon single stripe sign (CSSS) is associated with ischemic-pattern colonic injury. We report a 69-year-old woman with norovirus infection, hematochezia, recurrent left-sided colitis, and chronic NSAID use found to have CSSS on colonoscopy, suggesting a multifactorial "two-hit" mechanism involving NSAID-related mucosal vulnerability and transient hypoperfusion.

Azoreductase (AzoR) has emerged as a key player in reductive metabolism under hypoxia and a potential biomarker for hypoxia-associated pathologies, such as cancer and ulcerative colitis (UC). However, current clinical practice lacks a reliable method for real-time AzoR monitoring to effectively guide personalized therapies and assess treatment responses. We address this challenge by developing an AzoR-activatable near-infrared (NIR) fluorescent self-assembled probe, NFK-(Azo)-DCM, which combines self-assembly properties with hypoxia-specific activation through a rationally designed azobenzene unit. This molecular architecture enables a selective chemical transformation─the conversion of azobenzene to an electron-donating amino group under AzoR overexpression in hypoxic tissues─which initiates a cascade of NIR fluorescence signal amplification. Confocal imaging revealed that NFK-(Azo)-DCM exhibited statistically significant (P < 0.01) fluorescence enhancement in LLC, 4T1, and HEK293 cells under hypoxic conditions. In LLC tumor-bearing mice, the probe produced a 3.5-fold increase in the NIR fluorescence signal specifically in hypoxic tumor regions compared to the negative controls, establishing its utility for tumor bioimaging. Most notably, in a murine hindlimb ischemia model, the probe achieved rapid and accurate detection of AzoR activity through its NIR emission, with a strong linear correlation between the signal intensity and ischemic severity (R2 > 0.9). The diagnostic versatility of NFK-(Azo)-DCM was further validated in both the acute and chronic UC models. These findings establish NFK-(Azo)-DCM as a dual-functional platform capable of noninvasive, real-time monitoring of hypoxia-related diseases, providing a promising method for advancing research in AzoR-associated pathologies.

Ulcerative colitis (UC) demonstrates a bimodal incidence distribution, with a significant second peak and the highest prevalence observed in individuals aged ≥60 years. The pathogenesis of elderly UC involves immunosenescence-manifested by Th17/Treg imbalance and the accumulation of cells with a pro-inflammatory senescence-associated secretory phenotype (SASP)-alongside age-related dysbiosis, increased intestinal permeability, and mitochondrial dysfunction that impairs mucosal regeneration. Clinically, older patients more frequently present with left-sided colitis, characterized by anemia and weight loss, while abdominal pain is less common. Managing geriatric UC is challenging due to inadequate colonoscopy preparation and complex differential diagnosis (e.g., colorectal cancer, ischemic colitis). Furthermore, older adults face a fivefold increased risk of Clostridioides difficile infection and a sharply rising risk of colorectal cancer if diagnosed after 70 years of age. While 5-aminosalicylic acid remains the first-line therapy, it requires renal monitoring. Conversely, steroids increase infection and osteoporosis risks, thiopurines are restricted due to myelotoxicity and malignancy risks, and among biologics, vedolizumab offers better safety than anti-TNF agents. Ultimately, managing UC in older adults requires a comprehensive, multidisciplinary approach that accounts for multimorbidity, polypharmacy, nutritional status, and mental health to optimize pharmacotherapy and mitigate high-risk surgical interventions.

Ischemic colitis is a potentially life-threatening complication resulting from diminished blood flow to the colon. While the classic presentation is acute, crampy abdominal pain preceding hematochezia in older patients with cardiovascular comorbidities, it can present atypically in different demographics. The diagnosis can be established through appropriate clinical suspicion, along with endoscopic and histological confirmation. We report a case of amoxicillin-clavulanate-induced ischemic colitis in a young male without comorbidities. Following cessation of the medication, he demonstrated full clinical resolution of his symptoms. With this case report, we hope to highlight the importance of recognizing drug-induced ischemic colitis, specifically with the use of amoxicillin-clavulanate, an antibiotic commonly prescribed in outpatient clinical settings.

This study aimed to evaluate adverse events (AEs) associated with sevelamer through data mining of the US FDA Adverse Event Reporting System, identify potential drug-related AEs, and provide guidance for clinical medication safety. AE reports related to sevelamer from the first quarter of 2004 to the second quarter of 2025 were extracted from the US FDA Adverse Event Reporting System database, classified by preferred term (PT) and system organ class, and risk signals were analyzed. Among 6780 AE reports in which sevelamer was the primary suspect drug, 123 PTs spanning 24 system organ classes were identified. Male reports exceeded females (20.66% vs 18.07%), with highest proportion in 60 to 74 years (11.81%). Median AE occurrence time - medication date was 119.00 (interquartile range, 14.00, 476.50) days, with most events occurring more than 60 days after administration (n = 353, 30.46%) and within 7 days (n = 121, 10.44%). Among the positive risk signal PTs, "constipation, gastric or intestinal ulcer/hemorrhage/perforation/necrosis/ischemia, colitis ischemic, erosive esophagitis/gastritis, abdominal pain, dysphagia, nausea, vomiting, peritonitis and pruritus" exhibited high signal strength, consistent with the label. Additionally, new signals included aorto-esophageal fistula, diabetic gastroparesis, large intestinal stenosis, short-bowel syndrome, bezoar, diverticulum intestinal, gastric polyps, large intestine polyp, feces pale, diverticulum, hemorrhagic intestinal diverticulum, crystal deposit intestine, appendicitis (complicated or perforated), renal cyst infection, colonic or abdominal abscess, pseudomembranous colitis, diverticulitis, gangrene, pseudopolyp, mucosal ulceration or necrosis, skin fibrosis, and excessive granulation tissue. Therapeutic use of sevelamer remains associated with risks of diverse AEs. Therefore, clinical practice requires close monitoring of gastrointestinal disorders, metabolic, skin disorders and infections, particularly GI disorders. Prompt intervention is essential to prevent severe complications.

The hypothesis that protein kinase C (PKC) participates in the signaling stage of the cardioprotective response to the administration of probiotics was tested in experiments on male Wistar rats using a model of systemic inflammatory response syndrome (SIRS), which includes obesity and chemically induced colitis. To provide probiotic cardioprotective effects, Lactobacillus acidophilus (LA-5) and Bifidobacterium animalis subsp. lactis (BB-12) were administered orally. PKC inhibitor chelerythrine at a dose of 0.5 mg/kg was administered intraperitoneally 20 min before the start of isolated Langendorff heart perfusion. Global ischemia (30 min) and reperfusion (90 min) were simulated, after which the size of the necrosis zone was histochemically determined. In the SIRS group, we observed a significant increase in leukocyte count and the size of the necrosis zone (by 39%; p < 0.05) in comparison with the control. In groups with probiotic correction and PKC + probiotic, the size of the necrosis zone was significantly lower than in the SIRS group. Administration of chelerythrine did not abolish the cardioprotective effect of probiotics. In the SIRS model, probiotic-induced cardioprotection is mediated by mechanisms that prevent ischemic/reperfusion damage that differ from the PKC pathway.

Ischemic colitis remains a diagnostic challenge, as endoscopic grading of mucosal ischemia is subjective and insensitive for transmural infarction. While the majority of non-gangrenous cases are resolved conservatively, gangrenous mucosa necessitates immediate resection. The current reliance on visual signals, such as color and bleeding, results in misclassification and variability. We propose a novel deep learning approach to quantify micro-capillary refill dynamics from colonoscopy video. The technology produces objective perfusion measures and real-time viability classification by examining frame-by-frame color recovery following temporary mucosal blanching. This approach makes use of recent developments in AI-assisted colonoscopy, annotated datasets, and endoscopic hardware. By incorporating capillary refill analysis, operational decision-making might be improved, interobserver variability could be decreased, and unnecessary colectomy and delayed gangrene treatment could be avoided. Pilot studies are warranted to validate this concept and establish its role in guiding therapy for ischemic colitis.