Behсet's disease: intestinal damage

Abstract

Behсet's disease (BD) is a systemic vasculitis of an unknown etiology characterized by repeated oral and genital ulcerations and involvement of the eyes, joints, blood vessels, and other organs. In BD, it is the organ pathology that determines the severity and prognosis of the disease. The most difficult and least studied version of such changes is intestinal damage. Its verification in BD is complicated by a variety of clinical manifestations, their similarity with inflammatory bowel diseases, the lack of sufficiently informative laboratory tests, and pathognomonic endoscopic and histological signs. Intestinal BD (IBD) can result in serious complications (severe bleeding, intestinal perforation, and fistula formation), which may not only considerably reduce the quality of life of the patient, but also cause his death. Treatment for IBD is not standardized; it is mainly empirical and is performed as cycles. The goal of its therapy is to achieve clinical remission, to heal intestinal ulcers, to reduce recurrence rates, and to prevent surgery. The cumulative frequency of surgical interventions is as follows: 20% of them are performed in the first year, 27–33% within 5 years, and 31–46% within 10 years after IBD diagnosis. One of the problems in the surgical treatment of patients with IBD is the risk of a recurrence that often requires repeat surgery. Thus, 2- and 5-year postoperative recurrence rates were 29.2 and 47.2%, respectively. The poor prognostic factors are young age (<40 years), high disease activity at the time of diagnosis, detection of crateriform or deep ulcers at colonoscopy, high C-reactive protein level, and history of laparotomy.