Clinical Data Analysis Of32Cases Behcet’s Disease With Digestive System Manifestations

Aim:To raise awareness of the disease,reduce misdiagnosis rate and the incidence ofgastrointestinal complications by analysising clinical features,endoscopic andpathological characteristics,laboratory examination and treatment of Behcet’s diseasewith digestive system manifestations.Methods:Based on the1990International Study Group for Behcet’S Disease Diagnosticcriterion of Behcet’s Disease,we searched105cases about Behcet’s Disease on ourhospital with the keyword of Behcet’s disease or Behcet syndrome from2003to2013，eliminated the repeated cases of same institutions and selected32cases which havedigestive system manifestations,named the intestinal Behcet’s disease group．Then weretrospectively analyzed clinical data of the32cases of patients and those withoutdigestive system manifestations.Results：1、General information: There were105cases with Behcet’s disease in total,including32male patients and73female patients, ratio of male to female was1to2.3,the onset ageranged5years old to73years old,20-40years old patients percented57.1%,the diseaseduration ranged1week to34years.In intestinal Behcet’s disease group, there were15male cases,and17female cases, ratio of male to female was1to1.1. There were17male cases,and56female cases in Behcet’s disease group, ratio of male to female was1to3.3. The average onset age in intestinal Behcet’s disease group was34.91±16.64yearsold,whereas Behcet’s disease group was31.75±13.6years old. In intestinal Behcet’s disease group the average disease duration was11.32±9.64years,whereas the averagedisease duration of the Behcet’s disease group was7.15±7.99years. The average diseaseduration of intestinal Behcet’s disease group was longer than the Behcet’s diseasegroup,and there was statistical significance between these two groups（P<0.05）.2、System performance: In the intestinal Behcet’s disease group,the evidence of commonsymptoms were oral ulcers(93.8%), genital ulcers (78.1%), skin lesions (50%) and fever(40.6%).In the Behcet’s disease group, the evidence of common symptoms were oralulcers(98.6%), genital ulcers (82.2%), skin lesions (80.8%) and ocular diseases (19.2%).Comparison of intestinal Behcet’s disease group and Behcet’s disease group,there werehigher evidence of skin involvement in Behcet’s disease group,and higher evidence oftheating rate in intestinal Behcet’s disease group and there were statistical significancebetween the two groups（P<0.05）.8cases in intestinal Behcet’s disease group is positiveas acupuncture reaction,however in Behcet’s disease group12cases are positive.3、Digestive system manifestations:Abdominal pain was the most common symptom,and frequently represented to the right-lower abdomen．There were23cases ofabdominal pain in the intestinal Behcet’s disease group,21of which viewed theabdominal pain as the chief complains．13cases exhibited diarrhea,diarrhea appeared tobe the first symptoms in4cases.Other manifestations included perianal ulcer、abnormaldefecation、retrosternal burning pain、heart burning、dysphagia and abdominal mass.ect.4、Gastrointestinal complications: In intestinal Behcet’s disease group,there were4cases(12.5%) of small bowel obstruction,3cases (9.4%)of gastrointestinal bleeding and2cases(6.4%) of esophagus stenosis.1case with lower digestive tract bleeding thenpresented intestinal perforation.1case with abdominal pain presented intestinal fistulaand abdominal infection after twelve years.5、Concomitant disease: Comparison the concomitant disease of intestinal Behcet’sdisease group and the Behcet’s disease group,all two groups associated with appendiceallesions and tonsillitis,and higher evidence of appendiceal lesionsin the intestinalBehcet’s disease group, and there was statistical significance（P<0.05）.The evidence ofconcomitant disease of intestinal Behcet’s disease group were history of previous tuberculosis and ankylosing spondylitis,and in Behcet’s disease group washypothyroidism.6、Laboratory examination：ESR and CRP were usually elevated,and the result armaturetest was positive in the active phase of the disease.But there was no statisticalsignificance between these two groups in ESR、CRP、WBC、LYM、Hb、PLT andimmunological indicators.More cases with slightly decreased ALB level were involvedin the intestinal Behcet’s disease group,and there was statistical significance betweenthese two groups（P<0.05）.7、Endoscopy and pathology：Ileocecal was the most common site of lesions in theintestinal Behcet’s disease,the most common endoscopic manifestation was ulcer．Inthis group9patients accepted colonoscopy including5cases of ileocecal ulcer、2cases of anastomotic ulcer、1case of whole colon ulcer and1case of colitis.Thepathological results showed2cases vasculitis of8cases of intestinal ulcer cases,and6cases showed different degree of inflammation.11patients accepted gastroscopy,andshowed esophageal ulcer2cases, cardielcosis1case, gastric ulcer3cases,and chronicgastritis5cases.Among the6patients with endoscopic biopsy, pathological resultsshowed various degrees of inflammation.8、Treatment and sequele：The main treatment of these two groups was glucocorticoidhormone and immunosuppressant,sometimes combined with thalidomide、colchicineand immunomodulator.The intestinal Behcet’s disease patients who got intestinal ulcercould take mesalamine.It could be given PPI to patients with gastric ulcer and esophagalulcer.4cases also needed an operation, including2cases of ileocecal resection, and2cases underwent right hemicolectomy. The symptoms could be improved in most of thepeople,but one patient died of intestinal perfusion in intestinal Behcet’s disease group.Conclusion:1、 Most of the intestinal Behcet’s disease are young. Gastrointestinal symptomsappeara later than those of systemic manifestations of BD．2、Abdominal pain is the most common symptom,the second is diarrhea.There alsoinclude some complications：digestive tract bleeding、intestinal perforation、fistulaformation、intestinal obstruction and so on. 3、When the Behcet’s disease involve in digestive tract,ileocecal ulcer、gastric ulcer andesophagal ulcer are common.4、The main treatment include glucocorticoid hormone and immunosuppressant forintestinal Behcet’s disease, and the treatment of gastrointestinal symptoms is adjuvanttherapy.