J Korean Med Sci.  2005 Dec;20(6):971-976. 10.3346/jkms.2005.20.6.971.

Comparison of Behcet's Disease and Recurrent Aphthous Ulcer According to Characteristics of Gastrointestinal Symptoms

• Rhee SH
• Kim YB
• Lee ES

• KMID: 2157747
• DOI: http://doi.org/10.3346/jkms.2005.20.6.971

Abstract

Behcet's disease (BD) is a multisystemic chronic inflammatory disease. It is characterized by recurrent oral and genital ulcers, uveitis, skin lesions and other manifestations, including neurologic, vascular, joint, and gastrointestinal ulcers of variable severity. Recurrent aphthous ulcer (RAU) represents a very common, but poorly understood, mucosal disorder. If a patient of RAU without any other typical symptoms of BD has gastrointestinal symptoms, it is difficult to distinguish this RAU from true BD with gastrointestinal involvement. Because pathognomonic clinical features and tools are absent, the differential diagnosis of these two diseases relies on the characteristic clinical features and the judgement of an experienced physician. Sixty-five out of a total 960 RAU patients and forty-four of 556 BD patients with gastrointestinal symptoms between January 1996 and December 2003 participated in this study. All were evaluated with esophagogastroduodenoscopy and colonoscopy. Clinical, endoscopic and histopathologic findings were analyzed and ELISA tests were conducted to detect serum levels of ASCA and pANCA. No significant difference was found between the two groups. Differential diagnosis between RAU with gastrointestinal symptoms and BD with gastrointestinal involvement requires further prospective, large-scale study.

Keyword

Behcet's Syndrome; Stomatitis, Aphthous; Saccharomyces cerevisiae; Antibodies, Antineutrophil Cytoplasmic; Gastrointestinal Tract

MeSH Terms

Adolescent
Adult
Aged
Antibodies, Antineutrophil Cytoplasmic/blood
Antibodies, Fungal/blood
Behcet Syndrome/*diagnosis/immunology/pathology
Comparative Study
Diagnosis, Differential
Endoscopy
Female
Gastrointestinal Diseases/*diagnosis/immunology/pathology
Humans
Male
Middle Aged
Saccharomyces cerevisiae/immunology
Serologic Tests
Stomatitis, Aphthous/*diagnosis/immunology/pathology

Figure

• 

  Fig. 1 ASCA levels in patients with recurrent aphthous ulcer (RAU), Behçet's disease (BD), and healthy controls. Levels equal to or greater than 25 units are considered positive. Horizontal bar is the median value.

Reference

1. Shimizu T, Ehrlich GE, Inaba G, Hayashi K. Behçet disease (Behçet syndrome). Semin Arthritis Rheum. 1979. 8:223–260.

2. Yurdakul S, Tuzuner N, Yurdakul Z, Hamuryudan V, Yazici H. Gastrointestinal involvement in Behçet's syndrome: a controlled study. Ann Rheum Dis. 1996. 55:208–221.

3. Balabanova M, Calamia KT, Perniciaro C, O'Duffy JD. A study of the cutaneous manifestations of Behçet's disease in patients from the United States. J Am Acad Dermatol. 1999. 41:540–545.

4. Natah SS, Konttinen YT, Enattah NS, Ashammakhi N, Sharkey KA, Hayrinen-Immonen R. Recurrent aphthous ulcers today: a review of the growing knowledge. Int J Oral Maxillofac Surg. 2004. 33:221–234.

5. Main DM, Chamberlain MA. Clinical differentiation of oral ulceration in Behçet's disease. Br J Rheumatol. 1992. 31:767–770.

6. Bang D, Yoon KH, Chung HG, Choi EH, Lee ES, Lee S. Epidemiological and clinical features of Behçet's disease in Korea. Yonsei Med J. 1997. 38:428–436.

7. Kasahara Y, Tanaka S, Nishino M, Umemura H, Shiraha S, Kuyama T. Intestinal involvement in Behçet's disease: review of 136 surgical cases in Japanese literature. Dis Colon Rectum. 1981. 24:103–106.

8. Choi IJ, Kim JS, Cha SD, Jung HC, Park JG, Song IS, Kim CY. Long-term clinical course and prognostic factors in intestinal Behçet's disease. Dis Colon Rectum. 2000. 43:692–700.

9. Bayraktar Y, Özaslan E, Van Thiel DH. Gastrointestinal manifestations of Behçet's disease. J Clin Gastroenterol. 2000. 30:144–154.

10. Kodama H. Intestinal Behçet's. Surg Ther. 1977. 37:51–58.

11. Lee RG. The colitis of Behçet's syndrome. Am J Surg Pathol. 1986. 10:888–893.

12. Thach BT, Cummings NA. Behçet syndrome with "aphthous colitis". Arch Intern Med. 1976. 136:705–709.

13. Lebwohl O, Forde KA, Berdon WE, Morrison S, Challop R. Ulcerative esophagitis and colitis in a pediatric patient with Behçet's syndrome. Response to steroid therapy. Am J Gastroenterol. 1977. 68:550–555.

14. Lee KS, Kim SJ, Lee BC, Yoon DS, Lee WJ, Chi HS. Surgical treatment of intestinal Behçet's disease. Yonsei Med J. 1997. 38:455–460.

15. Choi IJ, Kim JS, Park MJ, Kim YS, Lee JH, Lee DH, Jung HC, Song IS, Kim CY. Evaluation of prognosis and cumulative operation rate of intestinal Behçet's disease in comparison with Crohn's disease. Korean J Gastroenterol. 2000. 36:504–514.

16. Lee CR, Kim WH, Cho YS, Kim MH, Kim JH, Park IS, Bang DS. Colonoscopic findings in intestinal Behçet's disease. Inflamm Bowel Dis. 2001. 7:243–249.

17. Sayek I, Aran O, Uzunalimoglu B, Hersek E. Intestinal Behçet's disease; surgical experience in seven cases. Hepatogastroenterology. 1991. 38:81–83.

18. Kim JS, Lim SH, Choi IJ, Moon H, Jung HC, Song IS, Kim CY. Prediction of clinical course according to the macroscopic type by colonoscopy in Behçet's colitis. Endoscopsy. 2000. 32:635–640.

19. Yoo TW. Morphological differences between Crohn's disease and intestinal Behçet's disease involving colon. 1993. Seoul: Yonsei Univ.;[dissertation].

20. Rump JA, Schölmerich J, Gross V. A new type of perinuclear anti-neutrophil cytoplasmic antibody in active ulcerative colitis but not in Crohn's disease. Immunobiology. 1990. 181:406–413.

21. Peeters M, Joossens S, Vermeire S, Vlietinck R, Bossuyt X, Rutgeerts P. Diagnostic value of anti-Saccharomyces cerevisiae and anti-neutrophil cytoplasmic autoantibodies in inflammatory bowel disease. Am J Gastroenterol. 2001. 96:730–734.

22. Targan SR, Landers CJ, Cobb L, MacDermott RP, Vidrich A. Perinuclear anti-neutrophil cytoplasmic antibodies are spontaneously produced by mucosal B cells of ulcerative colitis patients. J Immunol. 1995. 155:3262–3267.

23. Cohavy O, Bruckner D, Gordon LK, Misra R, Wei B, Eggena ME, Targan SR, Braun J. Colonic bacteria express an ulcerative colitis pANCA-related protein epitope. Infect Immun. 2000. 68:1542–1548.

24. Main J, McKenzie H, Yeaman GR, Kerr MA, Robson D, Pennington CR, Parratt D. Antibody to Saccharomyces cerevisiae (baker's yeast) in Crohn's disease. BMJ. 1988. 297:1105–1106.

25. Sendid B, Colombel JF, Jacquinot PM, Faille C, Fruit J, Cortot A, Lucidarme D, Camus D, Poulain D. Specific antibody response to oligomannoside epitopes in Crohn's disease. Clin Diagn Lab Immunol. 1996. 3:219–226.

26. Vermeire S, Peeters M, Vlietinck R, Joossens S, Den Hond E, Bulteel V, Bossuyt X, Geypens B, Rutgeerts P. Anti-Saccharomyces cerevisiae antibodies (ASCA), phenotypes of IBD, and intestinal permeability: a study in IBD families. Inflamm Bowel Dis. 2001. 7:8–15.

27. Kim BG, Kim YS, Kim JS, Jung HC, Song IS. Diagnostic role of anti-Saccharomyces cerevisiae mannan antibodies combined with antineutrophil cytoplasmic antibodies in patients with inflammatory bowel disease. Dis Colon Rectum. 2002. 45:1062–1069.

28. Krause I, Monselise Y, Milo G, Weinberger A. Anti-saccharomyces cerevisiae antibodies: A novel serologic marker for Behçets disease. Clin Exp Rheumatol. 2002. 20(4):Suppl 26. S21–S24.