Cutaneous manifestations and gastrointestinal disorders: Report of two emblematic cases.

Gastrointestinal (GI) diseases, such as inflammatory bowel diseases (IBD), can manifest themselves with intestinal and extra-intestinal symptoms. Among the latter, cutaneous manifestations, such as pyoderma gangraenosum (PG) and metastatic Crohn's disease (MCD), represent a possible onset of IBD, with or without simultaneous bowel alterations. In such cases, intestinal and skin lesions are supported by the same immune-mediated mechanism. We hereby report two cases of patients with skin manifestations together with signs and symptoms suggestive of IBD. IBD and some skin lesions arise from the same immune-mediated mechanism. A multidisciplinary approach to these immune-mediated diseases is needed for an early and correct diagnosis, which in turn may lead to the use of the right drug avoiding useless treatment.

Long term course of ulcerative colitis in the prebiologic era. A retrospective study in a tertiary referral center.

AIM: Several population-based studies have shown that long term prognosis of ulcerative colitis (UC) may be better than previously reported. The aim of this study was to evaluate the course of UC in a referral center cohort in the pre-biologic era and to identify possible prognostic factors. METHODS: All patients with established diagnosis of UC have been extracted from our GI Unit IBD Database. Clinical and demographic characteristics of all patients were recorded at the time of diagnosis. The disease course was retrospectively evaluated considering four primary end points: change in disease extension, need of corticosteroids, need of immunomodulators, and need of colectomy. The Kaplan-Meier survival method was used to estimate the cumulative probability of a course free of the outcome of interest. RESULTS: Eight hundred and seven UC patients diagnosed between 1984 and 2008 have been included: 21.8% had proctitis, 47.6% had distal colitis and 30.6% had extensive colitis. The median follow up after diagnosis was 91 months (range 12-596). The probability of extension of proctitis within 10 years was 39.7%. In the whole cohort, the 10 years probability of receiving corticosteroids and immunomodulators was 46.7% and 12.4%, respectively. The 10-year probability of colectomy was 6.5%. Extensive colitis was associated with a higher probability of receiving corticosteroids, immunomodulators and surgery. CONCLUSION: Long-term prognosis of UC is favourable for the majority of patients. Extensive colitis is the most relevant negative prognostic factor. Results from our referral center study are similar to that reported in population-based studies. Further studies are required to assess the possible impact of biologics and new treatment strategies on long term outcomes.

Natural history of ileo-caecal Crohn's disease after surgical resection. A long term study.

AIM: Surgery is an almost inevitable event in Crohn's disease (CD) but is not curative; postoperative recurrence follows a predictable course. Several factors potentially affecting the risk of recurrence have been investigated but results are largely inconclusive. The aim of the present study was to evaluate the long-term course of ileo-caecal CD after surgery and to identify possible predictors of clinical and surgical recurrence. METHODS: Patients with ileo-caecal CD who had undergone surgical resection and with at least one year of post-operative follow-up were studied. The postoperative course was retrospectively evaluated. The primary end-points were clinical recurrence (defined as reappearance of symptoms requiring steroid treatment in the presence of endoscopic and/or radiologic recurrence) and surgical recurrence, defined as need for reoperation. RESULTS: Two hundred and twelve patients were included in the study. Median follow-up after surgery was 117 months (interquartile range 51-216). The cumulative probability of a post-operative course without clinical and surgical recurrence after 30, 60, 90, 120 months was 78.2%, 69.4%, 58.0%, 50.6% and 97.0%, 96.4%, 85.6%, 72% respectively. Early surgery (within three years from diagnosis) was associated with a longer postoperative course without clinical recurrence compared with late surgery (performed after three years from diagnosis). None of the other clinical variables considered (gender, age, family history for IBD, smoking habits, pattern of CD, and postoperative prophylactic treatment) was associated with the risk of clinical and surgical recurrence. CONCLUSION: Surgery is an excellent treatment for patients with isolated ileo-caecal CD. The overall long-term outcome is good: by 10 years after operation approximately 50% of patients are free of clinical recurrence and over 70% do not require further surgery. Surgery, therefore, continues to play an important role in ileo-caecal CD and should therefore not be considered only a failure of medical treatment.