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-?1 (TGF-?1)], inflammatory factors [Interleukin-6 (IL-6) and Tumor necrosis factor-? (TNF-?), C reactive protein (CRP)] and oxidative stress indices [Superoxide dismutase (SOD), Malondialdehyde (MDA)]. Results: IFX+AZA rapidly reduced pro-inflammatory cytokines (TNF-? 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-?1 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-? 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