Behçet's disease: Gastrointestinal involvement

Reports indicate that the prevalence of gastrointestinal involvement of Behçet's disease (BD) shows geographic variation. Since no true population surveys are available, at least some of this variation could be due to selection bias. The usually reported prevalence is less than 1% among patients from the Western countries and the Middle East while this frequency becomes 10% or higher in the Far East with reports of around 25% from Japan. As in Crohn's disease (CD), gastrointestinal Behçet's disease (GIBD) is seen most commonly in the ileocecal area. Lesions in the esophagus and stomach are distinctly rare. It is quite difficult to differentiate GIBD from CD disease unless other stigmata of either condition are present. The rarity of rectal involvement and the absence of granulomas in GIBD can on occasion be helpful. On the other hand, the presence of these two features in CD (∼10% for rectal disease and 10-15% for granuloma formation) is not frequent either, reducing their usefulness in differential diagnosis. Thus far, outcome perforation is more common in GIBD (25-50%) than in Crohn's (∼2%). Management of GIBD is very similar to what we do in CD. Surgical treatment is reserved for complications like perforation, bleeding, obstruction, and stubborn fistula formation. Since relapses are frequent even under medical treatment, surgical resection should be conservative.