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Moreover, it is now recognized that any cause of mucosal cell apoptosis can lead to this pigmentation, such as NSAIDs and IBD, which can also induce epithelial cell apoptosis.25 Some researchers have found that anthraquinone laxatives are decomposed by bacteria that consequently produce a type of rhubarb derivative in the caecum.26 The rhubarb derivative damages the intestinal epithelial cells and then promotes the effects of the laxative but then can lead to death of these cells, which are immediately engulfed by nearby macrophages