Introduction
Pyoderma gangrenosum (PG) is a rare, neutrophilic dermatosis that is a well-established extraintestinal manifestation (EIM) of inflammatory bowel disease (IBD). The clinical implications of developing PG in patients with ulcerative colitis (UC) who undergo total proctocolectomy colectomy and ileal pouch anal anastomosis (TPC-IPAA) surgery remains unknown.
Methods
Study participants were selected from patients enrolled in the Carlino Family Inflammatory Bowel and Colorectal Disease Biobank between 1998 and 2021 with a pre-colectomy diagnosis of UC and who underwent TPC-IPAA surgery. A retrospective study comparing patients with PG and those without PG was performed. The outcomes that were measured included development of pouchitis, pouchitis classification, presence of pouch fistula, anal fistula, anal stenosis, and pouch failure.
Results
In this study, 357 IPAA patients were included, 10 of whom suffered PG. Patients with PG and without PG had similar demographics and clinical characteristics. Both groups had similar rates of pouchitis (80% in PG patients and 64% in patients without PG, p=0.504). However, IPAA patients with PG had a higher risk of developing pouch fistula (50% vs 10%, p=0.002), anal fistula (40% vs 12%, p=0.031), and Crohn’s-like disease of the pouch (70% vs 15%, p=0.003) compared to patients without PG. Patients who developed PG prior to their first episode of pouchitis were more likely to eventually experience pouch failure (OR: 20.7, 95% CI: 3.9, 110.7, q=0.003 after FDR adjustment).
Conclusions
Among UC patients who undergo TPC-IPAA surgery, development of PG portends poor pouch outcomes and is predictive of pouch failure.
objective of this work is the translation into Portuguese, adaptation to Brazilian culture and validation of the "IBD Disk" in Brazil. Methods: Adults patients with inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC) were recruited from January 2020 to March 2021, in follow-up at a reference center in IBD in Brazil. Sworn translations and retro-translations of the "IBD Disk" were performed and all parameters were analyzed by a committee composed of 3 physicians and a nutritionist who work with IBD, all fluent in the English language. Results: The translation and back-translation of the "IBD Disk" was carried out, with agreement between the sworn translators. In the final stage, the general assessment of the comprehensibility of all the items in the tool was high. The quality and adequacy indicators showed excellent adequate values. The IBD-Disk was evaluated for its reliability and reliability. The item-total correlation coefficients ranged from 0.518 to 0.750, considered ideal (reference .0.3). The total instrument presented Cronbach's alpha of 0.921 and composite reliability of 0.881, values above the cut-off point, therefore considered satisfactory.
Conclusion(s):The Portuguese version of IBD-Disk is a reliable and valid tool to assess disability in Brazilian IBD patients.
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