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P073. A comparative study of clinical, endoscopic and histologic findings in patients with gastrointestinal Behçet's disease and Crohn's disease

A.F. Celik1, I. Hatemi1, G. Hatemi1, E. Satir1, Y. Erzin2, S. Goksel3, O.S. Gultekin4, H. Yazici1

1Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey; 2Yeditepe University, Istanbul, Turkey; 3Acibadem Maslak Hospital, Istanbul, Turkey; 4Istanbul Gastroenterology Center, Istanbul, Turkey

Background: Gastrointestinal Behçet's Disease (GIBD) and Crohn's disease (CD) have similar clinical and endoscopic findings which are difficult to distinguish from one another. The aim of this retrospective survey is to analyze the symptoms, clinical, endoscopic and histopathological findings of our GIBD patients and compare them to our CD patients followed in the same setting.

Methods: All of our inflammatory bowel disease patients including GIBD patients are recorded under the same outpatient registry. GIBD is defined as any patient who fulfill International Study Group (ISG) criteria for Behçet's disease and have ileal or colonic ulcers in the abscence of NSAID use. CD was diagnosed with clinical, endoscopic, radiologic and histologic findings. None of our CD patients fulfilled ISG criteria. Since 1999, 40 patients have been diagnosed as GIBD. For the purposes of this study, we selected 2 CD patients for each GIBD patient. These were selected as the CD patient before and the one after each GIBD patient in our records. Symptoms, endoscopic findings and histologic findings of two groups were compared uing Student's t test and chi-square test. Multivariate analysis was used to determine the factors predicting GIBD.

Results: We evaluated 40 GIBD (23 men, 17 women, mean age 39.1±7.8), and 80 CD patients (46 men, 34 women, mean age 44±13.4). Clinical and endoscopic findings are summarised in the table. In multivariate analysis rectal bleeding, perforation and focal single ulceration were found to be associated with GIBD.

Table. Clinical, endoscopic and histologic findings of GIBD and CD patients
 GIBD (N = 40)CD (N = 80)p
Age at diagnosis33±8.237.3±13.80.03
Abdominal pain30/40 75%58/80 72.5%NS*
Diarrhea13/40 32.5%43/80 53.8%0.02
Bloody diarrhea3/40 7.5%16/80 20%NS
Gross rectal bleeding8/40 20%1/80 1.25%0.001
Perforation8/40 20%1/80 1.25%0.001
Weight loss1/40 2.5%20/80 25%0.002
Being Operated19/40 47.5%22/80 27.5%0.025
Age at the operation30.8±8.8938.7±13.70.04
Area of involvement
Colonic13 32%13 16%NS
Ileocolonic18 45%45 56.2%NS
Ileal8 20%21 26.5%NS
Other1 2.5%1 1.3%NS
Ulcer Location
Focal single34.5%7.7%0.004
Focal multiple41.4%46.2%NS
Number of ulcer
Single ulcer37.1%3.8%0.000
Multiple ulcers62.8%96.1%0.000
Cobblestone appereance0%20%0.000
Granulom (%)0/30 (0%)8/57 (14%)NS
*NS: Not significant.

Conclusion: The location of intestinal involvement is similar in the two diseases. Focal single ulceration and complications like perforation and gross rectal bleeding are more suggestive of GIBD. GIBD patients have more frequent and earlier surgical interventions than CD patients. Absence of granuloma in GIBD is not a distinctive feature for differentiating the two diseases.