Mimicry and deception in inflammatory bowel disease and intestinal behçet disease

Abstract

Behçet disease (BD) is a rare, chronic, multisystemic, inflammatory disease characterized by recurrent oral aphthous ulcers, genital ulcers, uveitis, and skin lesions. Intestinal BD occurs in 10-15% of BD patients and shares many clinical characteristics with inflammatory bowel disease (IBD), making differentiation of the 2 diseases very difficult and occasionally impossible. The diagnosis of intestinal BD is based on clinical findings-as there is no pathognomonic laboratory test-and should be considered in patients who present with abdominal pain, diarrhea, weight loss, and rectal bleeding and who are susceptible to intestinal BD. Treatment for intestinal BD is similar to that for IBD, but overall prognosis is worse for intestinal BD. Although intestinal BD is extremely rare in the United States, physicians will increasingly encounter these challenging patients in the future due to increased immigration rates of Asian and Mediterranean populations.

Keywords: Behçet disease; Crohn's disease; Intestinal Behçet disease; inflammatory bowel disease; ulcerative colitis.

Figure 1

Proposed classification scheme for differentiating between intestinal Behçet disease and Crohn's disease.

Figure 2

Algorithm for the diagnosis of intestinal Behçet disease (BD). *Subtypes of systemic BD were classified according to the diagnostic criteria of the Research Committee of Japan. **Close follow-up surveillance is necessary.