TNF and Cowden disease: NF-κB is a crucial transcriptional factor for mediating inflammation and TNFɑ expression in PBMCs.48,49 The anti-inflammatory effect of fidaxomicin may help treat CD because NF-κB activation positively correlates with histologic scores in CD patients.50 Although the role of anti-inflammatory medications in intestinal stricture development among CD patients is controversial,1,7 the dual anti-inflammatory and anti-fibrogenic effects of fidaxomicin may confer synergistic protection to CDS patients.