4484 Colonoscopic findings in intestinal behcet's disease.

Abstract

Background: Behcet's disease is a multisystemic chronic inflammatory disease characterized by oral ulcer, genital ulcer, skin manifestations and ocular involvements as major symptoms. Minor symtoms include arthritis or arthralgia, vascular lesion, CNS involvement, epididymitis, and intestinal ulcers. Intestinal involvement in Behcet's disease is not rare in Korea. Ulceration can occur in any part of the gastrointestinal tract including the esophagus, stomach and duodenum, but the ileo-cecal area is the most commonly involved site. Aim: The aim of this study was to characterize the colonoscopic findings of intestinal Behcet's disease. Methods: We retrospectively reviewed colonoscopic examinations in 92 patients with intestinal Behcet's disease. Among 92 patients, complete, incomplete, suspicious, and possible types included 16, 26, 24, and 18 cases, respectively. The remaining 8 cases did not have any major systemic manifestation of Behcet's disease. About 2/3 of the patients were diagnosed as Behcet's disease before intestinal involvement was identified. Twenty-four (26%) patients had a previous history of intestinal resection at the time of colonoscopy. Results: Abdominal pain (94%) was the most common symptom, followed by diarrhea (30%), melena/hematochezia (25%), weight loss, fever, indigestion and nausea/ vomiting. Colonoscopy demonstrated ulcerative lesions in all cases. Among patients who did not have operations, ileo-cecal area was the most commonly involved site (92%). Seven (8%) patients had ulcers in other parts of the colon. All of the operated patients had ulcers at the ileo-colonic anastomostic site. Most (95%) of the ulcers were round/oval or geographic in shape while longitudinal or circumferential ulcers were rare (5%). Sixty-one patients (66%) had a single ulcer, 19 (21%) had several (2-5) ulcers, and 12 (13%) had multiple (≥6) ulcers. The ulcer was small (≤ 10 mm) in 20 patients (22%), medium-sized (11-20 mm) in 20 (22%), and large (>20 mm) in 52 patients (57%). Mean size of ulcer was 3.0 cm. The ulcer was deep in 56 patients (61%) while shallow in 36 (39%). The margin of ulcer was discrete in 75 cases (82%), elevated and nodular in 56 cases (62%), and erythematous in 48 cases (52%). Mucosal changes adjacent to the ulceration such as erhthema and edema were not common, and were noted in 22 cases (24%). Conclusion: Typical colonoscopic finding in intestinal Behcet's disease included a single or a few deep ulcers with discrete margin and normal adjacent mucosa in the ileocecal area or ileo-colonic anastomotic site.