SAT0492 GASTROINTESTINAL MANIFESTATIONS IN CHILDHOOD BEHÇET’S DISEASE

Abstract

Background: Behcet’s disease (BD) is an idiopathic, chronic, inflammatory systemic vasculitis characterized by recurrent oral and genital aphthous ulcers, skin lesions, and ocular involvement. It can also affect multiple visceral organ and system such as heart, lung, blood vessels, gastrointestinal (GI) system, and central nervous system (1). The etiology of the disease is still unknown. New diagnostic criteria for pediatric Behcet’s patients have been established In 2015, and its largely based on clinical findings (2). Although the GI manifestations are not take part in to the diagnostic criteria, it can be emerge in great deal of patients and associated with significant morbidity and mortality. The most common GI symptoms in BD are abdominal pain, nausea, diarrhea and GI bleeding in, respectively. Also, the most common reported site of intestinal involvement was ileocecal. The literature data related to GI involvement of BD are frequently concern adult patients and pediatric studies are limited. Objectives: We analyzed the GI manifestations and its endoscopic findings in children diagnosed with BD. Methods: We retrospectively reviewed the clinical records of 64 patients who fulfilled the international pediatric classification criteria for BD from December 2015 to December 2018. Endoscopic examination results of 13 patients were also collected and analyzed. Results: Of the 64 children with BD, 37 were male and 27 were female, and sex ratio (male/female) was 1.37/1. The mean age of our patients was 9.49±4.10 and 11.52±3.50; at onset of symptoms and at the time of diagnosis, respectively. Assessment of our 64 patients revealed that the prevalence of GI symptoms is 60% (39/64). The most frequent GI symptoms were abdominal pain in 56% (36/64), chronic diarrhea in 18% (12/64), nausea/vomiting in 11% (7/64), chronic constipation in 12% (8/64), and regurgitation or heartburn in 7% (5/64). Upper GI endoscopy was performed in 7 patients and colonoscopy in 6. All of the patients who underwent the endoscopy or colonoscopy, had findings support the GI inflammation. The endoscopic findings shown in the patients are; gastric inflammation in 100% (7/7), oesophageal inflammation in 57% (4/7), duodenal inflammation in 42% (3/7), colonic erythema and inflammation in 83% (5/6), polyps in 50% (3/6), ulceration in 66% (4/6), and hemorrhoids in 16% (1/6). Upper GI ulceration was not observed. Pathology specimens were taken in 7 upper endoscopies and 6 colonoscopies within our patients. The findings of pathology specimens were vascular congestion and inflammation in 100% (7/7) of upper GI biopsies and 83% (5/6) of colonic biopsies, cryptitis in 66% (4/6) of colonic biopsies. Acute colitis in pathology specimens was shown in 83% (5/6) of the patients. Three of the patients with colitis had punch ulcers, and these patients were evaluated as BD-associated colitis. The other two patients were diagnosed and treated as Crohn’s colitis accompanying BD. Conclusion: The GI system is one of the most frequently affected organ by the BD. It may cause the inflammation and ulceration in the GI tract. Inflammatory bowel diseases can also cause GI inflammation similar to BD. In patients with symptoms of GI inflammation, upper and lower GI endoscopic examination and pathological analysis may be helpful in determine the underlying etiology.