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N015. Patient education on their disease as a determinant on the progression of complications. The role of specialized nursing

M. Morete1, J.A. Rodriguez1, M. Figueira1, A. Echarri1, 1Hospital A. Marcide, Gastroenterology, Ferrol, Spain

Background

Some extraintestinal manifestations of IBD cause symptoms that may be more tolerable if the patient understands their relationship with the disease. Pyoderma gangrenosum (PG) appears in 5% of ulcerative colitis regardless of their activity. It can occur in very noticeable and worrying forms, especially in mild disease. We present a recurrent PG in a patient who had two different attitudes towards the same complication; the aim is to demonstrate how education and easy access to specialized care may halt the progression of complications.

Methods

We will describe a case of a mild proctosigmoiditis controlled in our unit with biannual reviews. On two occasions the reviews were notable for PG, once because of its extension and the other due to its location. When faced with these complications the patient showed two different attitudes.

Results

47-year-old woman diagnosed with proctosigmoiditis in 2006 in treatment with topical mesalazine. In April of 2011, she was admitted to surgery due to a two-week history of a lesion in the pretibial region with purulent discharge. The lesion quickly began ulcerating and growing causing marked symptoms and anxiety. The patient sought care with her physician and in the emergency room on several occasions. During admission, dermatologist performed a skin biopsy. Based on a suspected diagnosis of PG, was transferred to our department after 3w. Given the significant physical and psychological symptoms infliximab induction was started, leading to a rapid response. The patient was discharged after 22 days of admission with follow-up in the IBD Nursing Unit where she underwent dressing changes and a reinforcement of health education. After the wound healed, infliximab was stopped, with the patient continuing azathioprine treatment. In June of 2012, the patient came in for consultation due to a 3-day history of a lesion on the left breast. Inspection revealed a nodular lesion with a small ulceration suggestive of PG. Treatment was started with decreasing doses of steroids and local dressing changes, with no hospitalization or iv therapy required. On this occasion, the patient did not have any pain or anxiety secondary to the lesion. She suspected the diagnosis with early consultation in the unit.

Conclusion

Patient understanding of their disease and complications may improve the progression of the clinical course and healthcare expenses. Consultation with IBD nursing contributes to an increase in levels of knowledge, allowing rapid access route to specialized care.