Differentiation between intestinal Behçet’s disease and Crohn’sdisease based on endoscopy

Abstract

Background/aim: Differentiating intestinal Behçet's disease (BD) from Crohn's disease (CD) is highly challenging, as they often mimic each other in terms of clinical manifestations. Endoscopy is an important modality for distinguishing bowel lesions. The study was designed to identify clinical manifestations that are easily confused and to evaluate the efficacy of endoscopy for distinguishing intestinal BD from CD by several overlapping signs. Materials and methods: The data from 111 patients with intestinal BD and 81 patients with CD were retrospectively analyzed. Logistic regression was applied to establish a prediction model based on endoscopic findings for the differential diagnosis. The diagnostic efficacy of endoscopy was verified using the area under the receiver operating characteristic (ROC) curve. Results: Among intestinal BD patients mucocutaneous lesions were the leading clinical manifestations. Gastrointestinal symptoms were common in CD but were rare in intestinal BD (P < 0.001). CD patients with moderate-to-severe activity were more common than intestinal BD patients presenting with equivalent activity (P < 0.05). Independent factors that distinguished intestinal BD from CD were solitary ulcer in the ileocecal area (P < 0.001), perianal abscess (P = 0.049), single segment (P < 0.001), round intestinal ulcer (P = 0.013), intestinal obstruction (P = 0.035), and fistula (P < 0.001). The scores ranged from-2 to 3. The area under the ROC curve was 0.874 (95% CI: 0.823-0.926) (P < 0.001). With a score of 1.5 as the diagnostic cutoff value, the sensitivity and specificity were 76.3% and 80.6%, respectively. Conclusion: Mucosal injuries were rarer in patients with intestinal BD than in those with CD. The differentiation model combining several endoscopy features appeared to be reliable for distinguishing between intestinal BD and CD.

Pilot case-control study to explore the value of intestinal ultrasound in the differentiation of two common diseases involving the ileocecal region: intestinal Behçet’s disease and Crohn’s disease

“…Under colonoscopy, ≤5, round, focal, non-aphthous and non- cobblestone lesions were suggestive of intestinal BD, whereas longitudinal and multiple ulcers were suggestive of CD. The AUC of colonoscopy was 0.874-0.955 according to the literature (11,25). As colonoscopy can only detect lesions on the mucosal surface of the large intestine and terminal ileum, some characteristics of deep lesions and small intestine manifestations remain unveiled.…”

“…Moderately high sensitivity and specificity were found for IUS in differentiating intestinal BD from CD. Several studies used other modalities, including demographic data, clinical manifestations, laboratory tests, cross-sectional imaging, and colonoscopic findings to differentiate the two diseases (9,11,12,(25)(26)(27). As for clinical manifestations, no gastrointestinal symptoms show a significant difference between BD and CD (7).…”

The History and Diagnosis of Behçet’s Disease

“…Longitudinal ulcers in a discontinuous distribution and cobblestone appearance are endoscopic features of IBD. However, neurologic involvement is not observed in IBD [46][47][48][49][50].…”

Clinical Characteristics and Risk Factors of Intestinal Involvement in Behçet’s Syndrome Patients：A Cross-Sectional Study from a Single Center

“…There were few reports on the incidence of intestinal BS in China, and the frequency of intestinal involvement among BS patients was about 17% reported from a small-sized case series (5). Our previous study found that some BS patients have typical ulcers under colonoscopy although they have no clinical symptoms of the gastrointestinal tract (6). Therefore, the frequency of intestinal BS in China may be higher than 17%.…”