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Discriminating potential of extraintestinal systemic manifestations and colonoscopic features in Chinese patients with intestinal Behçet's disease and Crohn's disease.

Li J, Li P, Bai J, Lyu H, Li Y, Yang H, Shen B, Qian JM - Chin. Med. J. (2015)

Bottom Line: The distinction between intestinal Behηet's disease (BD) and Crohn's disease (CD) is always challenging due to many overlapping clinical features.Based on univariate analysis, massive gastrointestinal hemorrhage, fever, and extraintestinal systemic manifestations were more common in intestinal BD patients (P = 0.022, 0.048 and 0.001, respectively), while diarrhea, intestinal obstruction, and perianal lesions were more common in CD patients (P = 0.002, 0.010, and 0.027 respectively).The discriminating algorithm composed of the above independent predictors had the highest area under the curve of 0.987 for distinguishing between the two diseases.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Peking Union Medical College Hospital, Beijing 100730, China.

ABSTRACT

Background: The distinction between intestinal Behηet's disease (BD) and Crohn's disease (CD) is always challenging due to many overlapping clinical features. We conducted a retrospective study to reveal valuable strategies for the differential diagnosis between intestinal BD and CD in Chinese patients based on their clinical and colonoscopic features.

Methods: Thirty-five intestinal BD patients and 106 CD patients hospitalized from January 1983 to January 2010, who had ulcerative lesions in the terminal ileum or colon under colonoscopy and no history of gastrointestinal operation except appendectomy before admission, were enrolled. Univariate and multivariate logistic regression analyses were conducted to find discriminating predictors among demographic data, clinical manifestations, and colonoscopic findings.

Results: Based on univariate analysis, massive gastrointestinal hemorrhage, fever, and extraintestinal systemic manifestations were more common in intestinal BD patients (P = 0.022, 0.048 and 0.001, respectively), while diarrhea, intestinal obstruction, and perianal lesions were more common in CD patients (P = 0.002, 0.010, and 0.027 respectively). Based on colonoscopy, focal involvement, ileocecal valve deformity, solitary ulcers, large ulcers (ulcer size > 2 cm), and circumferential ulcers were more common in intestinal BD patients (P = 0.003, 0.003, 0.014, 0,013, and 0.003, respectively), while segmental involvement, longitudinal ulcers, a cobblestone or nodular appearance, and pseudo-polyps were more common in CD patients (P = 0.003, 0.008, 0.023, and 0.002, respectively). Based on multivariate logistic regression analysis, diarrhea, extraintestinal manifestations, ulcer distribution, size, and type, and pseudo-polyps were independent discriminating predictors between the two groups (P = 0.048, 0.008, 0.006, 0.021, 0.002, and 0.041, respectively). The discriminating algorithm composed of the above independent predictors had the highest area under the curve of 0.987 for distinguishing between the two diseases.

Conclusions: Extraintestinal systemic manifestations and the characteristic colonoscopic features, such as ulcer distribution, size and type, helped to distinguish intestinal BD from CD.

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Related in: MedlinePlus

(a) A longitudinal ulcer in a patient with Crohn's disease (CD). (b) A circumferential ulcer in a patient with intestinal Behçet's disease. (c) An aphthous ulcer in a patient with CD.
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Figure 1: (a) A longitudinal ulcer in a patient with Crohn's disease (CD). (b) A circumferential ulcer in a patient with intestinal Behçet's disease. (c) An aphthous ulcer in a patient with CD.

Mentions: Data were collected including demographics (gender, age and disease duration), clinical manifestations (disease distribution, gastrointestinal symptoms, extraintestinal manifestations, and gastrointestinal complications), and colonoscopic findings. The disease distribution was determined by endoscopic and radiologic examinations. Gastrointestinal complications included perforation, fistulae, intestinal obstruction and massive gastrointestinal hemorrhage which were associated with hemodynamic instability, acute anemia, and/or the need for blood transfusion. Colonoscopic features included the ulcer distribution (focal involvement, segmental involvement), the number of ulcers in a local segment (1, or ≥ 2), ulcer type (longitudinal ulcer, circumferential ulcer, aphthous ulcer or irregular ulcer), cobblestone appearance, pseudo-polyps, and stricture. Focal involvement was defined as one local area with ulcerative lesions or two adjacent areas involved by continuous ulcerative lesions. Segmental involvement meant more than two areas with discontinuous ulcerative lesions. A circumferential ulcer was defined as a round or transverse, deep and well-demarcated ulcer. An aphthous ulcer was defined as a small (<1 cm), punched out, raised or a flat lesion with a white center [Figure 1a–c]. The cobblestone appearance was defined as a mucosal pattern with raised nodules, resembling the paving of the “Roman” road. Pseudo-polyps are defined as polypoid lesions which are usually small and isolated or multiple and scattered, though they can sometimes be giant in size. All images of colonoscopic examinations were reviewed by an expert endoscopist who was blinded from other information. Histologic features of biopsy specimens, which were paraffin-embedded and stained with hematoxylin and eosin, were evaluated for the presence of epithelioid granulomas and the appearance of vasculitis.


Discriminating potential of extraintestinal systemic manifestations and colonoscopic features in Chinese patients with intestinal Behçet's disease and Crohn's disease.

Li J, Li P, Bai J, Lyu H, Li Y, Yang H, Shen B, Qian JM - Chin. Med. J. (2015)

(a) A longitudinal ulcer in a patient with Crohn's disease (CD). (b) A circumferential ulcer in a patient with intestinal Behçet's disease. (c) An aphthous ulcer in a patient with CD.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4837844&req=5

Figure 1: (a) A longitudinal ulcer in a patient with Crohn's disease (CD). (b) A circumferential ulcer in a patient with intestinal Behçet's disease. (c) An aphthous ulcer in a patient with CD.
Mentions: Data were collected including demographics (gender, age and disease duration), clinical manifestations (disease distribution, gastrointestinal symptoms, extraintestinal manifestations, and gastrointestinal complications), and colonoscopic findings. The disease distribution was determined by endoscopic and radiologic examinations. Gastrointestinal complications included perforation, fistulae, intestinal obstruction and massive gastrointestinal hemorrhage which were associated with hemodynamic instability, acute anemia, and/or the need for blood transfusion. Colonoscopic features included the ulcer distribution (focal involvement, segmental involvement), the number of ulcers in a local segment (1, or ≥ 2), ulcer type (longitudinal ulcer, circumferential ulcer, aphthous ulcer or irregular ulcer), cobblestone appearance, pseudo-polyps, and stricture. Focal involvement was defined as one local area with ulcerative lesions or two adjacent areas involved by continuous ulcerative lesions. Segmental involvement meant more than two areas with discontinuous ulcerative lesions. A circumferential ulcer was defined as a round or transverse, deep and well-demarcated ulcer. An aphthous ulcer was defined as a small (<1 cm), punched out, raised or a flat lesion with a white center [Figure 1a–c]. The cobblestone appearance was defined as a mucosal pattern with raised nodules, resembling the paving of the “Roman” road. Pseudo-polyps are defined as polypoid lesions which are usually small and isolated or multiple and scattered, though they can sometimes be giant in size. All images of colonoscopic examinations were reviewed by an expert endoscopist who was blinded from other information. Histologic features of biopsy specimens, which were paraffin-embedded and stained with hematoxylin and eosin, were evaluated for the presence of epithelioid granulomas and the appearance of vasculitis.

Bottom Line: The distinction between intestinal Behηet's disease (BD) and Crohn's disease (CD) is always challenging due to many overlapping clinical features.Based on univariate analysis, massive gastrointestinal hemorrhage, fever, and extraintestinal systemic manifestations were more common in intestinal BD patients (P = 0.022, 0.048 and 0.001, respectively), while diarrhea, intestinal obstruction, and perianal lesions were more common in CD patients (P = 0.002, 0.010, and 0.027 respectively).The discriminating algorithm composed of the above independent predictors had the highest area under the curve of 0.987 for distinguishing between the two diseases.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Peking Union Medical College Hospital, Beijing 100730, China.

ABSTRACT

Background: The distinction between intestinal Behηet's disease (BD) and Crohn's disease (CD) is always challenging due to many overlapping clinical features. We conducted a retrospective study to reveal valuable strategies for the differential diagnosis between intestinal BD and CD in Chinese patients based on their clinical and colonoscopic features.

Methods: Thirty-five intestinal BD patients and 106 CD patients hospitalized from January 1983 to January 2010, who had ulcerative lesions in the terminal ileum or colon under colonoscopy and no history of gastrointestinal operation except appendectomy before admission, were enrolled. Univariate and multivariate logistic regression analyses were conducted to find discriminating predictors among demographic data, clinical manifestations, and colonoscopic findings.

Results: Based on univariate analysis, massive gastrointestinal hemorrhage, fever, and extraintestinal systemic manifestations were more common in intestinal BD patients (P = 0.022, 0.048 and 0.001, respectively), while diarrhea, intestinal obstruction, and perianal lesions were more common in CD patients (P = 0.002, 0.010, and 0.027 respectively). Based on colonoscopy, focal involvement, ileocecal valve deformity, solitary ulcers, large ulcers (ulcer size > 2 cm), and circumferential ulcers were more common in intestinal BD patients (P = 0.003, 0.003, 0.014, 0,013, and 0.003, respectively), while segmental involvement, longitudinal ulcers, a cobblestone or nodular appearance, and pseudo-polyps were more common in CD patients (P = 0.003, 0.008, 0.023, and 0.002, respectively). Based on multivariate logistic regression analysis, diarrhea, extraintestinal manifestations, ulcer distribution, size, and type, and pseudo-polyps were independent discriminating predictors between the two groups (P = 0.048, 0.008, 0.006, 0.021, 0.002, and 0.041, respectively). The discriminating algorithm composed of the above independent predictors had the highest area under the curve of 0.987 for distinguishing between the two diseases.

Conclusions: Extraintestinal systemic manifestations and the characteristic colonoscopic features, such as ulcer distribution, size and type, helped to distinguish intestinal BD from CD.

Show MeSH
Related in: MedlinePlus