Ileocolonic involvement in Behçet's disease: endoscopic and histological evaluation

Our aim was to document the frequency of gastrointestinal (GI) involvement of Behçet's disease (BD) at endoscopic examination. Also, we aimed to analyze whether GI lesions were correlated with other systemic components of BD.

Fifty patients with BD were enrolled in the study. Patients in whom optimal colonoscopic examination of both the colon and terminal ileum could be performed were included. An ileum biopsy was taken from all cases. Upper GI endoscopy findings, presence of genital ulcers, uveitis, dermatological lesions, pathergy test, neurological involvement and peripheral vasculitis, and laboratory findings were recorded. Thirty age- and sex-matched persons who had perfect bowel cleansing and had a macroscopically normal colon and terminal ileum at colonoscopy without any systemic diseases were enrolled as the control group.

Nine patients and 1 case had macroscopic ileum and colon lesions, respectively. Microscopic examination of BD patients with normal colon and terminal ileum at colonoscopy revealed 61% abnormal ileum histologies. That ratio was 30% for the control group (p < 0.001). None of the patients had any lesions suggesting BD at upper GI endoscopy. There was no correlation between macro- or microscopic GI involvement and other components of BD.

Lower GI tract, especially ileum involvement, is frequent in BD. Most of the patients have inflammation in the ileum even in the absence of macroscopic lesions.