Discriminating Potential of Extraintestinal Systemic Manifestations and Colonoscopic Features in Chinese Patients with Intestinal Behçet's Disease and Crohn's Disease

Abstract

Background:The distinction between intestinal Behçet's disease (BD) and Crohn's disease (CD) is always challenging due to many overlapping clinical features. We conducted a retrospective study to reveal valuable strategies for the differential diagnosis between intestinal BD and CD in Chinese patients based on their clinical and colonoscopic features.Methods:Thirty-five intestinal BD patients and 106 CD patients hospitalized from January 1983 to January 2010, who had ulcerative lesions in the terminal ileum or colon under colonoscopy and no history of gastrointestinal operation except appendectomy before admission, were enrolled. Univariate and multivariate logistic regression analyses were conducted to find discriminating predictors among demographic data, clinical manifestations, and colonoscopic findings.Results:Based on univariate analysis, massive gastrointestinal hemorrhage, fever, and extraintestinal systemic manifestations were more common in intestinal BD patients (P = 0.022, 0.048 and 0.001, respectively), while diarrhea, intestinal obstruction, and perianal lesions were more common in CD patients (P = 0.002, 0.010, and 0.027 respectively). Based on colonoscopy, focal involvement, ileocecal valve deformity, solitary ulcers, large ulcers (ulcer size > 2 cm), and circumferential ulcers were more common in intestinal BD patients (P = 0.003, 0.003, 0.014, 0,013, and 0.003, respectively), while segmental involvement, longitudinal ulcers, a cobblestone or nodular appearance, and pseudo-polyps were more common in CD patients (P = 0.003, 0.008, 0.023, and 0.002, respectively). Based on multivariate logistic regression analysis, diarrhea, extraintestinal manifestations, ulcer distribution, size, and type, and pseudo-polyps were independent discriminating predictors between the two groups (P = 0.048, 0.008, 0.006, 0.021, 0.002, and 0.041, respectively). The discriminating algorithm composed of the above independent predictors had the highest area under the curve of 0.987 for distinguishing between the two diseases.Conclusions:Extraintestinal systemic manifestations and the characteristic colonoscopic features, such as ulcer distribution, size and type, helped to distinguish intestinal BD from CD.

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

“…However, there are many differences between intestinal BD and CD on careful analysis. Research has historically suggested that mucocutaneous lesions were the most powerful discriminating factors between the diseases (11). Our study confirmed that oral ulcers, genital ulcers, mucocutaneous lesions, and hematological disease were suggestive factors for intestinal BD on univariate analysis.…”

“…It is easily misdiagnosed because there are no specific pathological or laboratory markers for the diagnosis of the entity. Several case reports and clinical studies highlighted the difficulties in making this distinction (5,(10)(11)(12)(13). To date, several discriminating endoscopic findings have been reported, including round shape, five or fewer lesions, focal distribution, and absence of aphthous and cobblestone lesions as features supporting the diagnosis of intestinal BD (12).…”

“…We also found that intestinal obstruction and fistula were two additional independent discriminating predictors. In addition to the differences on endoscopy, Li et al (11) found that massive gastrointestinal hemorrhage, fever, and extraintestinal manifestations were significantly more common in intestinal BD, while diarrhea, intestinal obstruction, and perianal abscess were more common in CD. Nevertheless, clinical manifestations are subjective and easily influenced by recall bias during a long disease course.…”

Heat shock protein family A member 6 combined with clinical characteristics for the differential diagnosis of intestinal Behçet’s disease

“…The diagnosis of intestinal BD and its differential diagnosis from other GI diseases are of great challenge for the clinicians due to their similar manifestations, especially from Crohn’s disease (CD) with ileocolonic involvement only. Both BD and CD are chronic and relapsing diseases that present as multi‐systemic inflammation and share similar colonoscopic features . In the previous studies, the criteria for differential diagnosis mainly focused on colonoscopic findings.…”

“…Both BD and CD are chronic and relapsing diseases that present as multisystemic inflammation and share similar colonoscopic features. 10 In the previous studies, the criteria for differential diagnosis mainly focused on colonoscopic findings. Round or ellipsoid ulcers, with focal distribution, single and deep location, clear and elevated margins and the rarity of aphthous ulcers or cobblestone appearance are characteristic colonoscopic features of intestinal BD.…”