Response to Medical Therapy, Course and Recurrence of Colonic Lesions in Behcet's Colitis

Cha, Sung Duk; Lim, Young Seok; Kim, Ji Won; Kim, Chan Gyoo; Kim, Joo Sung; Chang, Dong Kyung; Jung, Hyun Chae; Song, In Sung; Choi, Kyoo Wan; Kim, Chung Yong

Abstract

BACKGROUND AND AIMS: In order to study the course of Behqets colitis, we eva1uated the response to medical and surgical treatment of the patients with Behqets colitis.
METHODS
We analyzed 54 patients who were treated under the diagnosis of Behqets colitis for ten years between June, 1986 and December, 1996 at Seoul National University Hospital. Follow-up durations, symptoms, involved organs, involved sites, types of therapy, the response to therapy and response duration were evaluated.
RESULTS
With 29 male and 25 female patients, the male to female ratio was 1.16:1, and the mean age was 34 years. Post-therapy follow-up durations ranged from 3 months to 25 years with the mean being 59 months (+56 months). Most colonic lesions were found in the ileocecal area. 91% were found in the ileocecal rea, 28% in the ascending colon, 15% in the transverse colon, 13% in the descending colon, 13% in the sigmoid colon, and 2% in the rectum. Wben colonic lesions were classified according to location and multiplicity, localized solitaiy lesions accounted for 44%, diffuse multiple lesions were 31%, and localized multiple lesions were 24%. Among those who underwent meclical therapy initially, 74.4% had remission or improvement. In average it took 4 weeks to have a response and 31 months before recurrence occurred. After medical treatment 23% of the patients underwent surgical treatment due to intractablility. 44% of all patients underwent operation, total operation nwnber was 42. Causes of operation were as follows; int6stinal perforation 33%, uncertain diagnosis 26%, intractable abdominal pain 19%, intestinal fistula 12%, and intestinal obstruction 10%. Operation incidence rate was 15/100 person-year and the 5-year cumulative operation rate was 47%. Those who underwent multiple operations were 22% of all patients and 50% of operation cases. Operation rates of diffuse multiple lesions, localized multiple lesions, and localized solitary lesions were 29%, 31%, and 63%. Reoperation rates were 80%, 75%, and 33% each.
CONCLUSIONS
Behqet's colitis is a chronic recurrent disease. When medical therapy was effective, the response occurred within 8 weeks. Five-year cumulative operation rate was 47%. Re-operations were more frequent in diffuse multiple lesions, and explorative operations for confirmative diagnosis were more frequent in localized solitary lesions. Operations due to intestinal perforation made up 33% of all operations, so when the patients with Behcet's colitis were aggravated, we should consider the possibility of intestina1 perforation.