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Risk factors for peristomal pyoderma gangrenosum complicating inflammatory bowel disease
Xian-rui Wu1, Saurabh Mukewar, Ravi P Kiran
1Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Background And Aims:
Risk factors for peristomal pyoderma gangrenosum (PPG) are not well defined. The aim of this study was to evaluate risk factors associated with development of PPG.
Methods:
Both PPG patients and controls were obtained by searching a database of the Cleveland Clinic using the ICD-9 code from March 2005 to May 2011. The control group was selected by matching for underlying diseases and type of stoma in a ratio of 3:1. Univariate and multivariate analyses were performed.
Results:
A total of 15 PPG cases and 45 controls were included. The mean age at the time of PPG diagnosis was 46.0 ± 14.4 years. The underlying disease was Crohn's disease in 7 patients (46.7%), ulcerative colitis in 7 (46.7%) and indeterminate colitis in 1 (6.7%). Eleven patients (73.3%) had end ileostomy, 3 (20.0%) had loop ileostomy and 1 (6.7%) had colostomy. Eleven patients (73.3%) had active intestinal disease. In multivariate analysis, female gender, the presence of concurrent autoimmune disorders, and a high body mass index (BMI) were significantly associated with the presence of PPG, with odds ratios of 8.385 (95% confidence interval [CI]: 1.496-46.982, p=0.015), 6.882 (95% CI:1.438-32.941, p=0.016), and 9.895 (95% CI: 1.970-43.704, p=0.005), respectively. After a median follow-up of 12.8 (interquartile range: 7.9-20.1) months with appropriate therapy, PPG healed in 8 patients (53.3%) and improved in 7 (46.7%) patients, after treatment.
Conclusions:
Female gender, the presence of autoimmune disorders and a high BMI appeared to be associated with an increased risk for the development of PPG in IBD patients.
Insights
Female gender, autoimmune disorders, and high BMI are risk factors for peristomal pyoderma gangrenosum (PPG) in inflammatory bowel disease (IBD) patients. These findings aid in identifying individuals at higher risk for this rare complication.
Area of Science:
- Gastroenterology
- Dermatology
- Clinical Research
Background:
- Peristomal pyoderma gangrenosum (PPG) is a rare but debilitating complication of ostomy surgery.
- Risk factors for PPG development remain poorly understood, necessitating further investigation.
Purpose of the Study:
- To identify and evaluate potential risk factors associated with the development of peristomal pyoderma gangrenosum (PPG).
Main Methods:
- A retrospective case-control study was conducted using data from Cleveland Clinic (March 2005-May 2011).
- 15 PPG cases were matched with 45 controls based on underlying disease and stoma type.
- Univariate and multivariate analyses were employed to assess risk factors.
Main Results:
- Female gender, presence of autoimmune disorders, and high body mass index (BMI) were significantly associated with PPG.
- Odds ratios for these factors were 8.385 (female gender), 6.882 (autoimmune disorders), and 9.895 (high BMI).
- The majority of patients (53.3%) experienced healing of PPG after appropriate therapy.
Conclusions:
- Female sex, co-existing autoimmune conditions, and elevated BMI are significant risk factors for PPG in patients with inflammatory bowel disease (IBD).
- Early identification of these risk factors may allow for proactive management and improved outcomes for PPG patients.
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