Pyoderma Gangrenosum and inflammatory bowel disease: a combined medical and surgical approach - case report and literature review

OBJECTIVE

Pyoderma Gangrenosum (PG) is an immune-mediated neutrophilic dermatosis, characterized by large painful ulcers occurring in various body segments. It can be associated to Inflammatory Bowel Disease (IBD) including both Ulcerative Colitis and Crohn Disease. Prompt and effective management is fundamental, due to its high morbidity and mortality rates. By presenting our clinical experience, we aimed at showing the efficacy of a combined therapeutic approach, in which the best of every specialty cooperates managing this hazardous disease.

PATIENTS AND METHODS

We report on two patients attending our outpatient clinic with ulcerative skin lesions at the level of the back. Patient 1 suffered from Crohn disease and Patient 2 presented a positive history of abdominal pain, diarrhea with mucus and blood in the stool. Histological exam was performed with final diagnosis of PG associated with IBD. A Literature review was carried out in order to highlight the role of combined clinical-surgical management of PG in adult patients with IBD.

RESULTS

Complete resolution of the lesions was achieved in 4 months and 3 months for each patient respectively without relapse. PubMed was searched from 2000 to 2020 with the following keywords: (Pyoderma) AND/OR (Pyoderma Gangrenosum) AND (Inflammatory Bowel Disease) AND/OR (Ulcerative Colitis) AND/OR (Crohn Disease) AND (Management). Seven papers were included (4 case reports, 2 case series, 1 comprehensive review) and reviewed using a descriptive checklist.

CONCLUSIONS

PG should be treated by dedicated multidisciplinary teams, in which every specialist plays a crucial role from the diagnosis to the treatment and up to the long-term follow-up.

Beta-glucan, inositol and digestive enzymes improve quality of life of patients with inflammatory bowel disease and irritable bowel syndrome

OBJECTIVE

To evaluate the efficacy of a mixture of beta-glucan, inositol and digestive enzymes in improving gastrointestinal symptoms in patients affected by inflammatory bowel disease (IBD)-irritable bowel syndrome (IBS).

PATIENTS AND METHODS

The study was conducted at the IBD Unit of the University of Catanzaro. Forty-three IBD patients with IBS symptoms were included in the study. IBD diagnosis was performed by clinical, endoscopic, histological and radiological criteria. Patients were in clinical remission and in treatment only with systemical and topical mesalamine. All study participants fulfilled the Rome III criteria for the diagnosis of IBS. The study participants were randomized into 2 groups: group A (n=23) received conventional treatment (systemical and topical mesalamine) plus a mixture of beta-glucan, inositol and digestive enzymes (one tablet after lunch and dinner) for four consecutive weeks; group B (n=20) received only conventional treatment. The prevalence and intensity of gastrointestinal (GI) symptoms were evaluated both at the enrollment (T0) and after four weeks of treatment (T1).

RESULTS

Patients who received mesalamine plus the mixture of beta-glucan, inositol and digestive enzymes (group A) reported a reduction in abdominal pain together with reduction in bloating and flatulence after four weeks of treatment. Importantly, an overall improvement in the general well-being has been recorded. Patients who underwent only mesalamine treatment (group B) reported a mild reduction in the evacuative urgency without any other improvements.

CONCLUSIONS

We have shown that supplementation with a mixture of beta-glucan, inositol and digestive enzymes reduces bloating, flatulence and abdominal pain, improving the overall clinical condition of IBD-IBS patients.