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IBD-associated pyoderma gangrenosum in the biologic era

The most recent issue of the Alimentary Pharmacology & Therapeutics investigates inflammatory bowel disease-associated pyoderma gangrenosum in the biologic era, the response to therapy.

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Pyoderma gangrenosum in inflammatory bowel disease (IBD) is uncommon and therapeutically challenging.

Dr Andrews and colleagues from Australia and colleagues reported that its treatment remains poorly characterized due to limited individual center or practitioner experience.

No large series are reported since 2003, yet inflammatory bowel disease treatment has changed substantially.

The team provided an up-to-date review of the published treatment efficacy of currently available therapies for inflammatory bowel disease-related inflammatory bowel disease in the biologic era.

The researchers performed a systematic review of cases published post-2003 since the broad availability of anti-tumor necrosis factor-alpha therapy.

Cases which did not have coexistent inflammatory bowel disease, were non-English language, of pediatric age or without data on response to therapy were excluded.

The doctors analyzed 60 cases, of which 55% were female, 50% had ulcerative colitis, 45% had Crohn's disease, 5% had inflammatory bowel disease.

In 12%, trauma preceded pyoderma gangrenosum
Alimentary Pharmacology & Therapeutics

At pyoderma gangrenosum diagnosis, 58% had active and only 15% inactive inflammatory bowel disease, with 27% with inflammatory bowel disease activity unspecified.

Predominant sites were lower limb, and peristomally 42% had multiple lesions.

In 12%, trauma preceded pyoderma gangrenosum.

In 42%, new pyoderma gangrenosum appeared whilst on inflammatory bowel disease-specific therapy, whilst 28% were on no therapy, and in 30% inflammatory bowel disease therapy was unspecified.

Of patients on no therapy at pyoderma gangrenosum, 16 healed, 7 with first- and 8 with second-line therapy.

The doctors used in total, 34 out of 60 patients received infliximab, 4 received adalimumab, 2 had both, with 33 responding to one or the other.

There was no correlation of pyoderma gangrenosum duration or size with healing times.

Dr Andrews' team concludes, "Pyoderma gangrenosum appears predominantly during active inflammatory bowel disease and is seen equally in Crohn's disease and ulcerative colitis."

"New pyoderma gangrenosum may be a manifestation of recrudescent inflammatory bowel disease or it follow trauma."

"Anti-TNFa therapy as a first-line agent for pyoderma gangrenosum should be considered, as it appears to be highly effective."

Aliment Pharmacol & Ther 2013: 38(6): 563–572
23 August 2013

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