Clinical features analysis of 36 cases of intestinal Behcet's disease

Abstract

Objective To improve the knowledge of intestinal Behcet's disease. Methods From October 2012 to January 2014, 36 patients with intestinal Behcet's disease were collected. The general information of the patients, manifestation of Behcet's disease, digestive symptoms, lab findings, imaging findings, endoscopic examination results, treatment and prognosis of Behcet's disease were analyzed. Chi square test and Fisher exact probability test were performed for count data analysis. Single factor and multi factors of efficacy were analyzed by Logistic regression analysis. Results Among 36 patients with Behcet's disease (male 19 and female 17), the mean onset age was 26.5 years old and the average course of disease was (8.2±6.8) years. Symptoms of digestive system of 91.7% (33/36) patients showed up later than system manifestations of Behcet's disease appeared. All 36 patients had oral ulcer. The rates of genital ulcers, skin diseases, inflammation and joint disease were 63.9% (23/36), 58.3% (21/36), 25.0% (9/36) and 25.0% (9/36), respectively. The main symptoms of digestive system were abdominal pain, diarrhea, bloating and hemafecia, of which abdominal pain was the predominant symptom and the incidence rate was 75.0% (27/36). Gastrointestinal bleeding, intestinal perforation, intestinal obstruction and arteriovenous fistula were the common complications of Behcet's disease and the incidence rates were 36.1% (13/36), 2.8% (1/36), 2.8% (1/36) and 2.8% (1/36), respectively. Among patients with ocular lesions, male patients were more than female patients (male six and female three), and the difference was statistically significant (χ2=0.111, P<0.05). Erythrocyte sedimentation rate increased in 55.6% (20/36) patients. C–reactive protein was positive in 27.8% (10/36) patients. Nine patients received computed tomography (CT) examination, there were five cases with thickened bowel wall and one case with proliferative lesions at ileocecal valve. Ileocecum was the predilection site, and accounted for 36.1% of the disease (13/36). Endoscopic appearance was mainly ulcers. Pathological examination indicated non–specific acute and chronic gastrointestinal mucosal inflammation and the formation of inflammatory granulation tissue. Twerty–two patients received sulfasalazine (SASP) treatment and 24 patients accepted glucocorticoid therapy. After Behcet's disease recurrence, five patients received combined immunosuppressive therapy, five patients received immunosuppressive therapy and tumor necrosis factor (TNF) antagonist treatment, and nine patients received TNF antagonist treatment. All the patients treated together with proton pump inhibitor (PPI). Twelve patients without glucocorticoid treatment took thalidomide and immunosuppressive therapy. The efficacy was good in patients with immunosuppressive therapy or TNF antagonist treatment and the recurrence rate was low (r=3.984, P<0.05). Conclusions Most patients with intestinal Behcet's disease are young adults. Symptoms of digestive system show up later than system manifestations of Behcet's disease appeared. Ileocecum is the predilection site of digestive system. The common endoscopic appearance is ulcers. Corticosteroids and sulfasalazine are the main therapy, which could be much more effective when combined with tumor necrosis factor antagonists or immunosuppressive therapy. Key words: Intestinal Behcet's disease; Clinical features; Endoscopes