P583 Clinical: Therapy & observation
Sequential Change of Endoscopic Findings and Therapeutic Efficacy of Anti-TNF alpha therapy for Patients with Intestinal Behçet's Disease
Y. Hirayama*1, 2, O. Watanabe1, M. Nakamura1, T. Yamamura1, H. Goto1
1Nagoya University Graduate School of Medicine, Departmant of Gastroenterology and Hepatology, Nagoya, Japan, 2Tokai Central Hospital, Department of Endoscopy, Kakamigahara, Japan
Behçet's disease (BD) is a systemic inflammatory disease characterized by repeated oral and genital ulcerations, ocular lesions, skin manifestations, arthritis, vasculitis, and gastrointestinal involvements. Intestinal BD is characterized by intestinal inflammation with round and oval ulcers typically in the ileocecum and is associated with gastrointestinal symptoms, which are often uncontrollable, relapsing, and can cause acute intestinal bleeding or perforation. Despite a wide range of treatment options, a significant proportion of patients with intestinal BD remain refractory to medical therapy. We conducted this study in an attempt to clarify the sequential change of endoscopic findings, and therapeutic efficacy of treatment options for patients with intestinal BD.
We retrospectively reviewed the medical records of 43 consecutive patients who regularly underwent colonoscopy and double-balloon enteroscopy for intestinal BD from January 2004 to September 2014. Diagnosis of intestinal BD was based on the Mason-Barnes criteria. For the endoscopic efficacy assessment, the volume of the largest ileocecal or colonic ulcer which was product of the largest and shortest ulcer diameter and ulcer depth was compared. The sequential change rate of ulcer volume was also assessed.
43 patients (M/F: 27/16) who underwent colonoscopy for intestinal BD were enrolled. Median age at diagnosis was 42 years (13-77 years). Median age was 51 years (23-82 years). Disease duration was 8.4 ± 7.6 years. 32 patients (49%) have oral aphtus ulcer, 16 patients (37.2%) have skin lesions, 9 patients (20.6%) have uveitis, and 5 patients (11.6%) have genital ulcer (including overlapping cases). The disease locations (65 lesions) were 34 cases of ileocecal valve and cecum (52.3%), 8 cases of rectum (12.3%), 8 cases of ascending-descending colon (12.3%), 6 cases of small intestine (9.2%), 4 cases of sigmoid colon (6.2%), 4 cases of esophagus (6.2%), and 1 case of stomach (1.5%) (including overlapping cases). Among 34 ileocecal valve and cecum cases, 23 cases (67.6%) showed typical oval deep ulcer. Among several treatment options, anti-TNF alpha therapies (Infliximab and Adalimumab) showed the highest median improvement rate of ulcer volume (74.4%), and the lowest relapse rate (10%). Between patients treated with anti-TNF alpha therapy (group A, n=10) and patients treated with conventional therapy (corticosteroid, immunomodulators and 5-ASA) (group B, n=33), there was a statistically significant difference (p<0.05).
Anti-TNF alpha therapies have potentially positive effect in inducing and maintaining remission for patients with intestinal BD.