Recurrent Oral Ulcers Research Articles

A Bistable Switch in HIV Disease Outcome for Antibody Treatment Following the Onset of Recurrent Aphthous Oral Ulcers

When challenged with foreign macromolecules, the humoral immune system produces an efficient response of antibody production (Skerra, 2003). However, the human immunodeficiency virus (HIV) evades CD4 T helper cells, the central component of generating neutralizing antibodies that orchestrate specific responses to a wide range of viruses (Wodarz & Nowak, 2002). When understanding the dynamic between HIV pathogenesis and immune system response, verbal reasoning proves insufficient because of the inherent complexity of the interactions involved. In particular, verbal reasoning may overlook subtle nuances, intricate feedback loops, and nonlinear relationships that are fundamental to comprehending the progression of HIV infection and the host immune response. Thus, mathematical models have proven useful in understanding how virus-antibody dynamics alter the course of HIV infection by capturing a set of assumptions and deducing logical conclusions through altering key parameters. Many studies have utilized chimeric simian-human immunodeficiency virus (SHIV) as a comparable animal model for HIV pathogenesis (Ciupe et al., 2018). It has been found that broadly neutralizing monoclonal antibodies (bnMAbs) have exceptional in vitro potency against a high-dosage mucosal HIV challenge, but the strength of protection in both high-dose and low-dose challenges is dependent upon the ratio between concentration of bnMAbs and size of the viral challenge (Moldt et al., 2012; Hessell et al., 2009). In simpler terms, the effectiveness of vaccines relies heavily on the balance between the amount and strength of antibodies produced by the immune system and the size of the virus challenge; if there are not enough strong antibodies to fight off a large amount of virus, the vaccine may not be as effective. Therefore, understanding the concentration and avidity of antibodies in relation to the size of viral inoculum proves important in developing vaccines that offer robust protection against HIV.

Behçet's Disease, Pathogenesis, Clinical Features, and Treatment Approaches: A Comprehensive Review.

Behçet's disease is a systemic inflammatory disorder of unknown etiology. The disease manifests with diverse clinical symptoms, most commonly recurrent oral and genital ulcers, skin lesions, and uveitis, though it can affect multiple organ systems. Diagnosis is primarily clinical due to the lack of a definitive diagnostic test, and management involves a multidisciplinary approach to control inflammation and manage symptoms. Current treatment strategies involve corticosteroids, immunosuppressive agents, and, increasingly, biological therapies. Behçet's disease exhibits a higher prevalence along the Silk Road, suggesting a role of environmental and genetic factors. Despite significant progress in understanding its clinical characteristics and treatment approaches, gaps remain in our understanding of its pathogenesis. Future research is needed to elucidate the disease's pathophysiology and optimize treatment strategies.

Autoinflammatory syndromes mimicking Behçet's disease with gastrointestinal involvement: a retrospective analysis.

This retrospective study aimed to investigate the clinical characteristics and genetic findings in paediatric patients with gastrointestinal involvement in Behçet's disease (BD), elucidating the spectrum of autoinflammatory syndromes mimicking BD in this young population. Fifty paediatric patients diagnosed with BD between January 2016 and December 2022, including 24 (48%) with gastrointestinal involvement, underwent comprehensive analysis. Clinical presentations, laboratory examinations, gastrointestinal endoscopy, and genetic tests were conducted, with patients stratified based on genetic results for rigorous comparative clinical analysis. The cohort, with a median age of disease onset at 4.0 years, predominantly manifested with recurrent oral ulcers (100%). Gastrointestinal symptoms were prevalent in 83.3%, with abdominal pain (70%) and haematochezia (16.7%) being notable. Endoscopic evaluations unveiled lesions primarily in the terminal ileum and ileocecal region, with diverse ulcers across various anatomical sites. While 70.8% initially met ICBD criteria, only 41.6% fulfilled new paediatric classification criteria. Genetic analysis in 18 patients unveiled pathogenic variants in 7, with the genetic-positive group exhibiting earlier onset and more atypical symptoms. Noteworthy cases included X-linked deficiency in ELF4, A20 haploinsufficiency, and Majeed syndrome, with two cases revealing chromosomal abnormalities such as trisomy 8 syndrome. Comparative analysis underscored earlier disease onset, heightened inflammatory markers, and distinctive gastrointestinal lesions in the genetic-positive cohort. Identification of monogenic diseases and chromosomal abnormalities resembling BD underscores the imperative of precise diagnosis for tailored treatment and genetic counselling. Expanding genetic screening initiatives holds promise for enhancing our comprehension of the genetic landscape associated with BD.

Oral Aphthous-like Ulcers Response to Topical Therapy in Young Adult Woman with Beta-Thalassemia Intermedia

Background: Beta thalassemia may have some oral manifestations. Oral mucosa ulcer may be one of the oral manifestations of beta-thalassemia. The oral ulcer may resemble recurrent aphthous stomatitis (RAS). This current case report aims to present an aphthous oral ulcer as a manifestation in young adult women with beta-thalassemia. Case report: A 28-year-old woman complained of recurrent painful oral ulcers in the labial mucosa. She was diagnosed with beta-thalassemia intermedia three years before. The ulcer may take 3-4 weeks to heal completely. Intraoral examination revealed two yellowish ulcers, 5 mm and 10 mm, surrounded by an erythematous halo, regular margin on left lips mucosa, oral ulcer pain scale measured medium level by visual analogue scale (VAS). The oral aphthous-like ulcer was taken for diagnosis in this case. Topical treatment was given to the oral ulcer using chlorine dioxide gel three times daily. After 10 days, the oral aphthous-like ulcer was healed. Conclusion: An oral aphthous-like ulcer may be the oral manifestation in beta-thalassemia patients, and the oral ulcer may respond well to topical treatment commonly used in recurrent aphthous stomatitis (RAS) patients. Hence, it is important to recognize oral conditions as one clinical manifestation in beta-thalassemia patients and choose the appropriate treatment to accelerate oral ulcer healing.

Short- and long-term outcomes of surgical treatment in patients with intestinal Behcet's disease.

Behcet's disease (BD), a chronic vasculitic disorder affecting multiple organs, is characterized by recurrent oral and genital ulcers, arthritis, vasculitis, and intestinal ulcers. Although intestinal involvement of BD is common in East Asia, the efficacy and long-term outcomes of surgical treatment of intestinal BD still remain to be established. To evaluate the postoperative clinical course of intestinal BD and determine factors associated with its recurrence. Data from patients who underwent surgical treatment for intestinal BD between January 2010 and August 2021 were retrospectively reviewed. Patients' demographics, clinical features, postoperative course, complications, and follow-up data were evaluated. We analyzed 39 surgeries in 31 patients. The mean patient age was 45.1 years, and the mean interval between the diagnosis of intestinal BD and surgical treatment was 4.9 years (range 1.0-8.0 years). The most common indication for surgery was medical intractability (n = 16, 41.0%), followed by fistula or abscess (n = 11, 28.2%). Laparoscopic approaches were used in 19 patients (48.7%), and 5 patients (12.8%) underwent emergency surgeries. The most common surgical procedure was ileocecal resection (n = 18, 46.2%), followed by right colectomy (n = 11, 28.2%). A diverting stoma was created in only one patient (2.6%). During a mean follow-up period of 45 (range 8-72) months, eight cases (20.5%) of recurrence in five patients required reoperation. The interval between operations was 12.1 months (range 6.3-17.8 mo). Four patients (10.3%) experienced recurrence within 1 year postoperatively, and all eight recurrences occurred within 2 years of the initial surgery. The reoperation rates at 1 and 3 years were 10.3% and 20.5%, respectively. A redo ileocolic anastomosis was performed in all recurrent cases. In multivariate Cox regression analysis, emergency surgery [hazard ratio (HR) 9.357, 95% confidence interval (CI): 1.608-54.453, P = 0.013] and elevated C-reactive protein (CRP) levels (HR 1.154, 95%CI: 1.002-1.328, P = 0.047), but not medication use, were predictors of recurrence. Surgical resection is a feasible treatment option for complicated BD. Reoperation is associated with severe inflammatory conditions, reflected by increased CRP levels and the requirement for emergency surgery.

Clinical efficacy of recombinant human basic fibroblast growth factor combined with ranitidine in the treatment of recurrent oral ulcer and its effect on serum TNF, IL-2 and T-lymphocyte subsets.

To evaluate the clinical efficacy of recombinant human basic fibroblast growth factor (rh-bFGF) combined with ranitidine in the treatment of recurrent oral ulcer and its effects on serum TNF, IL-2 and T-lymphocyte subsets. This was a retrospective study. Eighty patients with oral ulcers admitted to First Medical Center, Chinese PLA General Hospital from July 2021 to June 2022 were randomly divided into the control group and the experimental group (n=40). Patients in the control group were given topical treatment with rh-bFGF gel, while those in the experimental group were given oral treatment combined with ranitidine based on the control group, and both groups were treated continuously for 14 days. The therapeutic effect, pain relief time, ulcer healing time, as well as the differences in the levels of inflammatory factors and T-lymphocyte subsets were compared and analyzed between the two groups. The overall response rate of the experimental group was 92.5%, while that of the control group was 75%, with a statistically significant difference(P=0.03). After treatment, inflammatory factors indexes in the experimental group were significantly lower than those in the control group, with statistically significant differences (P=0.00). The indexes of T-lymphocyte subsets in the experimental group were significantly higher than those in the control group after treatment, with statistically significant differences (P=0.00). Recombinant human basic fibroblast growth factor combined with ranitidine is effective in the treatment of recurrent oral ulcers, boasting various benefits such as effectively promoting ulcer healing, reducing pain and inflammatory response, and enhancing immune function.

B12 deficiency-related glossitis is highly associated with high gastrin-17 and low pepsinogen I.

The causes of vitamin B12 (B12) deficiency are varied and mainly related to gastric disorders. Glossitis is a common oral manifestation of B12 deficiency and is often first seen by dentists. This study aimed to investigate the correlation between B12 deficiency-related glossitis (B12-def glossitis) and gastric serum biomarkers [gastrin-17(G17), pepsinogen I (PGI), pepsinogen II (PGII), and anti-Helicobacter pylori (H. pylori) antibodies], and preliminarily discuss the etiology of B12-def glossitis. A cross-sectional study was conducted in patients complaining of glossodynia, burning sensation, or severe recurrent oral ulcers, but patients with a history of gastrectomy were excluded. All subjects underwent a uniform oral examination and hematological tests. Of 243 patients, 133 with B12-def glossitis were in the case group, and 110 with other oral mucosal diseases (non-glossitis) and normal B12 levels were in the control group. In the case group, 84.2% (112/133) showed high G17 and low PGI levels (G17hi PGIlow ). Univariate logistic regression showed that G17hi PGIlow was a high-risk factor for B12-def glossitis (OR: 92.44; 95% CI: 35.91, 238.02). Subgroup analyses in the case group showed that the G17hi PGIlow group presented with lower B12 levels and a lower positive rate of anti-H. pylori antibodies compared to the non-G17hi PGIlow group. Gastric serum biomarkers in patients with B12-def glossitis generally showed G17hi PGIlow , suggesting possible atrophy of gastric corpus and fundus mucosa. The G17hi PGIlow and non-G17hi PGIlow groups may represent different etiologies of B12 deficiency.

Co(II) Metal-Organic Complex: Fluorescence Performances and Loaded With Drug Vitamin B2 Hydrogels Against Recurrent Oral Ulcers.

A new coordination polymer (CP) based on Co(II), namely, {[Co3(L)2(4,4'-bipy)(DMA)2]·H2O}n(1) has been synthesized after reacting Co(NO3)2·6H2O with H3L ligand in the existence of N-donor ligand 4,4'-bipyridine (4,4'-bipy), via utilizing a flexible tricarboxylic acid ligand 5-((formic acid-3-sulfur)methyl)isophthalic acid (H3L) with -S-CH2- joint. Additionally, the excellent blue fluorescence properties of CP 1 were confirmed through fluorescence spectroscopy compared to the original ligand. Using natural polysaccharide hyaluronic acid (HA) and carboxymethyl chitosan (CMCS) as raw materials, HA/CMCS hydrogel was prepared by chemical synthesis method. Taking vitamin B2 as the drug model, we designed and synthesized gels loaded with vitamin B2 metal framework and evaluated their efficacy in the treatment of recurrent oral ulcer.

Salivary and Serum Levels of Both Uric Acid and C-Reactive Protein (CRP) Biomarkers in Patients with Behçet's Disease

Behçet's disease (BD) is a systemic vasculitis identified by recurrent oral and genital ulcerations, skin inflammations and uveitis, with unknown etiology. This study had been designed to assess the level of salivary and serum uric acid (UA) and C - reactive protein (CRP) markers in BD patients as activity markers and to explore their relations in disease existence. Fifty BD patients :( 32 males and 18 females) with mean age (35.3 ± 7.6) years and fifty healthy subjects (30 males and 20 females) with mean age (34.8± 9.1) years were involved in this study that extend during the period of (2014-2016). All of patients and healthy subjects were analyzed for UA by (colorimetric spectrophotometric assay that based on oxidation of UA by uricase enzyme to allantoin) and CRP by (qualitative analysis: antigen-antibody interaction Latex agglutination test) in both saliva and serum. Data was analyzed using descriptive statistics, t-test, P (ANOVA) test, Chi-square (2) test, and Pearson’s linear correlation coefficient statistical analyses. Results of this study show that salivary uric acid was significantly elevated in BD patients than in healthy subjects. (P<0.001). Although serum UA was higher in patients than the healthy subjects but statistically not significant. (P=0.57). On the other hand, out of fifty patients there were thirteen patients (26%) significantly expressed CRP positive in their serum and saliva. The results of this study revealed that UA can act as prooxidant (pro inflammatory) marker and CRP as inflammatory marker that could be related to impaired endothelial function in BD.

Human Leukocyte Antigen-B51 Association and Behcet’s Disease in Saudi Arabia

Introduction: Behcet’s disease (BD) is a chronic systemic inflammatory vasculitis of unknown etiology, characterized by recurrent oral ulcers, genital ulcers, skin lesions, ocular lesions, and other systemic manifestations. The pathogenesis of BD is unclear. Multiple studies have suggested close correlation between BD and human leukocyte antigen-B51 (HLA-B51) as a genetic factor. In our study, we aim to identify the association of HLA-B51 as a risk factor and its association with the multiple clinical signs and symptoms of Saudi BD patients in the kingdom of Saudi Arabia. Materials and Methods: A retrospective study was conducted at a tertiary treatment center in the rheumatology subspecialty clinics, Riyadh, Saudi Arabia, from 2013 to 2018. The study was conducted by searching the hospital database for BD and HLA-B51. Results: HLA-B51 positivity was observed in 20 of the 38 patients in our sample, accounting for about a quarter of the total (52.6%). Conclusion: Our retrospective study found that HLA-B51 was positive in 52.6% of Saudi patients attending a single tertiary care center. However, a larger multicenter study is required to validate these observational data.

Gastrointestinal Behçet's disease: Manifestations, diagnosis, and management

Behçet's disease (BD) is a rare, inflammatory vascular disorder with recurrent oral and genital aphthous ulcers, along with ocular and cutaneous manifestations. Gastrointestinal (GI) BD may involve any portion of the GI tract. However, it is commonly described in the terminal ileum, followed by the ileocecal region. Diagnosis is challenging given lack of pathognomonic tests; therefore, it is based on clinical criteria. Management of intestinal BD includes different classes of medications including corticosteroids, 5-aminosalicylic acid, immunomodulators, and anti-tumor necrosis factor alpha monoclonal antibody agents. In this review, we aim to focus on intestinal BD and provide details of clinical manifestations, diagnosis and therapeutic options of intestinal BD from gastroenterology viewpoint.

Comparative Study on the Efficacy of Kangfuxin Liquid Combined with Oral Ulcer Powder of Recurrent Oral Ulcers: A Meta-analysis

Comparative Study on the Efficacy of Kangfuxin Liquid Combined with Oral Ulcer Powder of Recurrent Oral Ulcers: A Meta-analysis

Huanglian Jiedu Wan intervened with “Shi-Re Shanghuo” syndrome through regulating immune balance mediated by biomarker succinate

With increasing stress in daily life and work, subhealth conditions induced by “Shi-Re Shanghuo” syndrome was gradually universal. “Huanglian Jiedu Wan” (HLJDW) was the first new syndrome Chinese medicine approved for the treatment of “Shi-Re Shanghuo” with promising clinical efficacy. Preliminary small-sample clinical studies have identified some notable biomarkers (succinate, 4-hydroxynonenal, etc.). However, the correlation and underlying mechanism between these biomarkers of HLJDW intervention on “Shi-Re Shanghuo” syndrome remained ambiguous. Therefore, this study was designed as a randomized, double-blind, multicenter, placebo-controlled Phase II clinical trial, employing integrated analysis techniques such as non-targeted and targeted metabolomics, salivary microbiota, proteomics, parallel peaction monitoring, molecular docking and surface plasmon resonance (SPR). The results of the correlation analysis indicated that HLJDW could mediate the balance between inflammation and immunity through succinate produced via host and microbial source to intervene “Shi-Re Shanghuo” syndrome. Further through the HIF1α/MMP9 pathway, succinate regulated downstream arachidonic acid metabolism, particularly the lipid peroxidation product 4-hydroxynonenal. Finally, an animal model of recurrent oral ulcers induced by “Shi-Re Shang Huo” was established and HLJDW was used for intervention, key essential indicators (succinate, glutamine, 4-hydroxynonenal, arachidonic acid metabolism) essential in the potential pathway HIF1α/MMP9 discovered in clinical practice were validated. The results were found to be consistent with our clinical findings. Taken together, succinate was observed as an important signal that triggered immune responses, which might serve as a key regulatory metabolic switch or marker of “Shi-Re Shanghuo” syndrome treated with HLJDW.

Behçet Syndrome, Clinical Presentation and Risk Factors

Behçet's syndrome, a systemic vasculitis, manifests across multiple organ systems, presenting challenges in diagnosis and management. This chronic condition, characterized by recurrent oral and genital ulcers, cutaneous lesions, headaches, and ocular symptoms, poses complexities in its clinical evolution. The elusive etiology, potentially rooted in autoimmune reactions triggered by infection or environmental factors, complicates diagnostic endeavors. Diagnosis relies on evolving clinical criteria, necessitating the exclusion of other diseases, with imaging aiding in localizing symptoms. The differential diagnosis involves careful distinction from conditions with similar presentations. Ongoing research explores the intricate interplay of genetic factors, immunology, and environmental influences. A comprehensive understanding holds promise for refined diagnostics and targeted interventions, improving outcomes for those affected.

Immediate Analgesic Effect of Non-thermal CO2 Laser Therapy (NTCLT) on Oral Ulcers in a Kidney Transplant Patient with Leukopenia

Introduction: The significant and immediate analgesic effect of Non-thermal CO2 Laser Therapy (NTCLT) as an efficient, safe, and innovative photobiomodulation (PBM) approach has been demonstrated in some painful oral lesions, such as recurrent oral aphthous ulcers, oral lesions of pemphigus vulgaris, and oral mucositis due to chemotherapy of solid tumors. Case Presentation: We report a case of a kidney recipient patient hospitalized due to pancytopenia, fever, and painful oral ulcers. According to the clinical features of the oral lesions and after extensive workups, drug-induced leucopenia, and the resultant leucopenia-induced oral ulceration were the most acceptable diagnoses for the patient. She was referred to our laser department for pain reduction of her painful oral ulcers by NTCLT. The CO2 laser (power: 1 watt) was irradiated through a thick layer of a completely transparent gel with very high water content while scanning the surface of the lesion with rapid circular motion of the defocused handpiece. Results and Conclusions: The pain of the patient's oral ulcer was relieved immediately and dramatically after NTCLT without any visible thermal side effects. The procedure was completely painless, and anesthesia was not required. The results of this report suggest that NTCLT can be considered a promising procedure for significant and instant pain relief of leucopenia-induced oral ulceration in kidney recipient patients without any thermal complications.

Identification of hub genes and gene modules associated with Behçet's disease by weighted gene co-expression network analysis of neutrophil transcriptome.

Behçet's disease (BD) is a chronic inflammatory condition with recurrent skin lesions, uveitis, and oral and genital ulcers. Neutrophils are important in the pathogenesis of BD, but their molecular mechanisms are unclear. We performed weighted gene co-expression network analysis on the transcriptome of neutrophils from 10 BD patients and 10 healthy controls to identify hub genes and gene modules associated with BD. We found eight co-expression modules with different biological functions. The turquoise module was involved in response to hydrogen peroxide and reactive oxygen species, the blue module was involved in response to external stimulus and inflammatory response, and the brown module was involved in the type I interferon signalling pathway. We further identified hub genes and transcription factors in each module by using module membership and gene significance. Our results reveal novel gene modules and hub genes that are associated with neutrophil activation and dysfunction in BD, which could serve as potential biomarkers and therapeutic targets for this disease.

Concurrence of familial Mediterranean fever and Behçet’s disease: a case report and review of the literature

BackgroundFamilial Mediterranean fever and Behçet’s disease are distinct disorders that are prevalent in the Mediterranean and Middle Eastern populations. They are characterized by unprovoked inflammatory episodes caused by overexpression of proinflammatory cytokines. Although reported previously, the overlapping presentation of familial Mediterranean fever and Behçet’s disease remains uncommon.Case presentationA 46-year-old Lebanese–Canadian man who presented with recurrent oral and genital ulcers, polyarticular synovitis, ocular swelling, recurrent infections, and fevers was later found to have heterozygous mutations of pathogenic MEFV c.2080A > G (p. Met 694Val) and c.2082G > A (p.Met694IIe) genes indicating familial Mediterranean fever. He was treated with prednisone, colchicine, and azathioprine, with inadequate symptoms control. Treatment was complicated by recurrent infections.ConclusionsOur case contributes to the growing literature demonstrating the presentation of predominantly Behçet’s disease-like features in the setting of diagnosis of familial Mediterranean fever. These findings emphasize that clinicians should be aware that patients with familial Mediterranean fever may present with Behçet’s disease-like clinical manifestations.

Cyclic Neutropenia Mimicking Crohn's Disease: Two Case Reports and a Narrative Review.

Cyclic neutropenia is a rare hematological condition characterized by periodic fluctuations in neutrophil counts, with a 21-day periodicity. Clinical presentation varies from mild to severe forms of the disease, with the onset of recurrent fever, painful oral ulcers, recurrent bacterial infections, peritonitis, and septic shock. The availability of granulocyte colony-stimulating factor (G-CSF) has revolutionized the management and natural history of this disease, regulating the proliferation, differentiation, and maturation of the progenitor cells, and reducing the duration of neutropenia. Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is a group of chronic pathologies that affect the gastrointestinal tract. The onset of both diseases may be at a young age (even during childhood or adolescence), and clinical manifestations may lead to misdiagnosis, due to similar characteristics such as recurrent infections, oral ulcers, perianal abscesses, and infertility. Moreover, the two pathologies are rarely associated, with different management and therapeutic options. Here, we describe two case reports of patients who underwent surgery because of diagnosis of complicated CD. After surgery, due to persistent neutropenia, the hematologist consultant confirmed suspicions of cyclic neutropenia, and G-CSF therapy was started with benefits, underlining the crucial importance of proper differential diagnosis.

Gluten Intolerance and Its Association With Skin Disorders: A Narrative Review.

Gluten sensitivity is defined as a chronic intolerance to gluten ingestion in genetically predisposed individuals. The etiology is thought to be immune-mediated and has a variable dermatologic presentation. Celiac disease (CD) is one of the most common forms of gluten intolerance and encompasses a wide range of extra-intestinal pathology, including cutaneous, endocrine, nervous, and hematologic systems. Psoriasis, another long-term inflammatory skin condition, has been linked to significant symptomatic improvement with a gluten-free diet (GFD). Palmoplantar pustulosis (PP), a variant of psoriasis, and aphthous stomatitis, which causes recurrent oral ulcers, have also exhibited beneficial results after the dietary elimination of gluten. In addition to this, dermatitis herpetiformis (DH), another immune-mediated skin disorder, is genetically similar to CD and has, therefore, shown tremendous improvement with a GFD. Another highly prevalent long-term skin condition called atopic dermatitis (AD), however, has revealed inconsistent results with gluten elimination and would require further research in the future to yield concrete results. Hereditary angioedema (HA) has shown an association with gluten intolerance in some patients who had symptomatic benefits with a GFD. Similarly, vitiligo and linear IgA bullous dermatosis have also shown some clinical evidence of reversal with a GFD. On the contrary, rosacea enhances the risk of developing CD.This narrative review emphasizes the potential impact of gluten intolerance on different cutaneous conditions and the potential therapeutic effect of a GFD on various symptomatic manifestations. There is a need for additional clinical and observational trials to further expand on the underlying pathophysiology and provide conclusive and comprehensive recommendations for possible dietary interventions.

Measuring the Whole Wall Thickness of the Common Femoral Vein as a Distinctive Diagnostic Tool to Distinguish Behçet's Disease Presenting with Oral Ulcers from Recurrent Aphthous Stomatitis.

Recurrent oral ulcers, which are the first and most common manifestation of Behçet's disease (BD), have several etiological causes but are often idiopathic and known as recurrent aphthous stomatitis (RAS). In recent years, publications have drawn attention to the fact that whole-wall thickness (WWT) and intima-media thickness (IMT) measurements of the common femoral vein (CFV) may be useful in the diagnosis of BD, which are independent of organ involvement. In this study, the usefulness of the WWT and IMT of the CFV measured by venous Doppler ultrasound (US) was investigated in differentiating BD presenting with oral ulcers from RAS. Patients with BD (n = 84), patients with RAS (n = 85), and healthy controls (HCs) (n = 70) were the three groups included. Both the right and left WWT of the CFV were significantly higher in the BD compared with the HCs and RAS groups (p < 0.001). The diagnostic cutoff values of ≥0.58 mm for the WWT of the CFV performed well against both the patients with RAS and HCs for the discrimination of BD (sensitivity = 79.8%, specificity = 64.7%). In patients with recurrent oral ulcers, the WWT of the CFV measurement may be a distinctive new diagnostic tool for the differential diagnosis of BD and RAS.