Esophageal involvement in Behçet's disease. Is endoscopy necessary?

Twenty patients who were diagnosed as having Behçet's Disease between 1976 and 1990 were asked to attend the dermatology department so that their diagnosis could be reviewed in the light of recently established criteria for the diagnosis of Behçet's disease. Ten patients fulfilled the diagnostic criteria, nine of whom agreed to participate in this endoscopic study. Nine patients underwent upper gastrointestinal endoscopy, three of whom had dyspepsia alone, two had dysphagia and dyspepsia, one had symptoms of acid regurgitation, and the remainder were asymptomatic at the time of endoscopy. One patient had evidence of grade 1 reflux esophagitis, one had an incidental pyloric canal ulcer, and one patient who had severe dysphagia on presentation was found to have a high esophageal stricture with accompanying ulceration. Behçet's disease rarely affects the esophagus but when present can cause marked esophagitis with consequent stricture formation. Since the incidence of esophageal involvement was low (11%), we conclude that unless the patient had marked esophageal symptoms there is no indication for routine endoscopy of patients with Behçet's disease.