P281. Characteristics, treatment and long term follow up of gastrointestinal Behçet's disease, IBD clinic experience
I. Hatemi1, G. Hatemi2, Y. Erzin1, B. Baca3, S. Goksel4, H. Yazici2, A.F. Celik1, 1Istanbul University Cerrahpasa Medical Faculty, Gastroenterology, Istanbul, Turkey, 2Istanbul University Cerrahpasa Medical Faculty, Rheumatology, Turkey, 3Istanbul University Cerrahpasa Medical Faculty, Surgery, Istanbul, Turkey, 4Acibadem Hospital, Pathology, Istanbul, Turkey
We aimed to report the long term follow up of our gastrointestinal Behçet's disease (GIBD) patient cohort, including their treatment modalities.
We retrospectively reviewed the all charts of Behçet's disease (BD) patients. All registered patients were evaluated for their current condition by senior gastroenterologist team.
73/8111 recorded BD patients had GI symptoms and macroscopic inflammatory lesions in endoscopy. 18/73 of these had other reasons. The remaining 55 patients had been diagnosed as GIBD (Table). The presenting symptoms; abdominal pain (30/55), diarrhoea (21/55), acute abdomen caused by perforations (n = 12), massive bleeding (n = 6). Surgery performed in 20/55 patients (36%), 6 for bleeding, 13 for perforation and 1 for intractable duodenal ulcer. Postoperative recurrence;10/20. In 3 of these patients remission occurred with thalidomide (Th) plus azathioprine (AZA), in 2 with AZA, in 2 with infliximab and in 1 with methotrexate. After a mean follow-up of 7.1±4.8 years (range 0.25–17 years), 44 (80%) patients were in long term remission and 14 (25%) were off treatment. Five (9%) patients, were still active. Three (6%) had died due to non-GI related reasons and 3 (6%) were lost to follow-up. Mortality arrived from pulmonary artery thrombosis, infection and chronic renal failure and end stage amyloidosis. Remission with no relapses was achieved during follow-up of 44.3±46.9 months in 17/26 patients who had initially been prescribed AZA (2.5 mg/kg). In 6/10 patients who had been prescribed 5-ASA remission was maintained during 45±50 months. 2/4 patients who were resistant to 5-ASA and achieved remission by AZA. 13 patients had relatively severe symptoms and persistent ulcers despite AZA treatment. Endoscopic and symptomatic remission could be obtained with Th in 3, infliximab in 3, adalimumab in 1, and etanercept in 1 patients. In 1 patient remission was obtained by surgery and in another 1 patient by hemapoetic stem cell transplantation.
|Patients with GI involvement of BS (n)||55|
|Age (years), mean±SD||38.5±9.1|
|at diagnosis of GIBS||31.2±7.1|
|Genital ulcers||45/55 (82%)|
|Positive pathergy reaction||30/55 (54%)|
|Papulopustular lesions||35/55 (64%)|
|Neurologic parenchymal involvement||3/55 (5%)|
|Location of gastrointestinal involvement, n (%)|
|Ileocecal region||16/55 (29%)|
|Duodenal bulbus||1/55 (2%)|
Abdominal pain with or without diarrhoea is the most prominent and frequent symptom of GIBD. Only 3/4 of BD patient with endoscopic lesions may have GIBD. 80% remission rate after a mean of 7 years of follow-up suggests that burden of GI disease is confined to the early years of the disease. 5-ASA compounds or AZA provided remission and prevented relapses in 2/3 of the patients. In resistant and relapsing cases management with Th or anti-TNF-alpha on AZA was effective in 8/13 patient.