BACKGROUND/AIMS: The cumulative surgery rate and postoperative relapse of intestinal Behcet’s disease (BD) have been reported to be high. This study aimed to establish a scoring system based on follow-up endoscopic findings that can predict intestinal BD recurrence after surgery. METHODS: Fifty-four patients with intestinal BD who underwent surgery due to bowel complications and underwent follow-up colonoscopy were retrospectively investigated. Their clinical data, including colonoscopic findings, were retrieved. Classification and regression tree analysis was used to develop an appropriate endoscopic classification model that can explain the postsurgical recurrence of intestinal BD most accurately based on the following classification: e0, no lesions; e1, solitary ulcer < 20 mm in size; e2, solitary ulcer ≥ 20 mm in size; and e3, multiple ulcers regardless of size. RESULTS: Clinical relapse occurred in 37 patients (68.5%). Among 38 patients with colonoscopic recurrence, only 29 patients had clinically relapsed. Multivariate analysis identified higher disease activity index for intestinal BD at colonoscopy (hazard ratio [HR], 1.013; 95% confidence interval [CI], 1.005 to 1.021; p=0.002) and colonoscopic recurrence (HR, 2.829; 95% CI, 1.223 to 6.545; p=0.015) as independent risk factors for clinical relapse of intestinal BD. Endoscopic findings were classified into four groups, and multivariate analysis showed that the endoscopic score was an independent risk factor of clinical relapse (p=0.012). The risk of clinical relapse was higher in the e3 group compared to the e0 group (HR, 6.284; 95% CI, 2.036 to 19.391; p=0.001). CONCLUSIONS: This new endoscopic scoring system could predict clinical relapse in patients after surgical resection of intestinal BD.
Behcet Syndrome ; Classification ; Colonoscopy ; Endoscopy ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Postoperative Care ; Recurrence* ; Retrospective Studies ; Risk Factors ; Trees ; Ulcer

Due to similar manifestations of intestinal Beh?et's disease (BD) to those of other colitis such as Crohn's disease or intestinal tuberculosis, it is still challenging for gastroenterologist to accurately diagnose intestinal BD in patients with ileo-colonic ulcers. Moreover, no reliable diagnostic criteria for intestinal BD have been developed yet. Therefore, IBD Study Group of KASID was formulated to establish the guideline for the diagnosis of intestinal BD using a modified Delphi process. The novel diagnostic criteria for intestinal BD were developed based on two aspects; colonoscopic findings and extra-intestinal systemic manifestations, in which patients were categorized into 4 groups including definite, probable, suspected, and non-diagnostic for intestinal BD. Furthermore, Disease Activity Index for intestinal BD was developed through a Korean multicenter study. These diagnostic and disease activity guidelines will contribute to understand intestinal BD.
Behcet Syndrome/classification/*diagnosis ; Blood Chemical Analysis ; Colonic Diseases/*diagnosis ; Colonoscopy ; Diagnostic Imaging ; Hematologic Tests ; Humans ; Severity of Illness Index

The criteria employed for Korean Behcet's disease (BD) from January 1990 to December 2000 have been investigated, and the diagnostic validity for those criteria was determined. For the generation of a modified set of preliminary criteria from the International Study Group (ISG) criteria, the diagnostic values for individual feature of BD were calculated. The criteria by the Behcet's Disease Research Committee of Japan appeared to be widely employed with the ISG criteria. However, because the ISG criteria revealed a relatively valid outcome in Korea, the application of this criteria will be needed for the universal unification until the criteria with better performance comes out. On the other hand, the modified set of preliminary criteria that consisted of the clinical items with better results seemed to improve some pitfalls of the ISG criteria. Although that criteria showed better performance than the preexisting criteria, it should be necessary to validate its effectiveness in other areas.
Behcet Syndrome/classification ; Behcet Syndrome/diagnosis* ; Behcet Syndrome/epidemiology ; Bibliometrics ; Data Collection ; Databases, Factual ; Human ; Korea/epidemiology ; Likelihood Functions ; Prevalence ; Sensitivity and Specificity

This study was to clarify whether Behcet's disease (BD) could be classified into the spondyloarthropathy (SpA) complex. It was undertaken on 58 patients with BD (BD group), 56 patients with SpA (SpA group), and 3 patients who concurrently satisfied the criteria for BD and SpA (BDSpA group). The clinical parameters and known susceptible HLA antigens were compared between BD group and SpA group. In addition, 3 patients in BDSpA group were reviewed. The prevalence of definitive sacroiliitis (SI) in BD group and SpA group was 46.4% and 5.2%, respectively. However, none had a definitive SI in healthy controls. Enthesitis was observed in 3.4% of BD group and in 50% of SpA group. The patterns of eye involvement were different between these two groups. HLA-B27 was negative in all 49 patients of BD group, whereas it was positive in 67.9% of SpA group. The prevalence of HLA-B51 was 51.7% in BD group, and that in SpA group was 21.4%. One patient in BDSpA group was considered to have concurrent BD and ankylosing spondylitis (AS). Another patient was closer to AS, and the third to BD. Conclusively, it seems that BD could not be classified into the SpA complex.
Adult ; Behcet Syndrome/*classification/immunology/pathology ; Eye/pathology ; Female ; HLA-B Antigens/analysis/immunology ; HLA-B27 Antigen/analysis/immunology ; Humans ; Lumbar Vertebrae/pathology/radiography ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pelvis ; Radioactive Tracers ; Sacroiliac Joint/pathology/radiography ; *Spondylarthritis/immunology/pathology ; Tomography, Emission-Computed, Single-Photon

Behcet's disease occurs with a high prevalence in the Far East including Korea. In this report we inspected 1,155 patients with Behcet's disease and collected information concerning the clinical and epidemiologic features of Behcet's disease in Korea. In summary, patients in their 30s were the most common, with the most common age of onset in the 20s; the sex ratio was 0.63:1 with female predominance; according to revised Shimizu's classification, the order of frequency of the different types was incomplete (38.2%), suspected (25.4%), possible (20.3%) and complete (16.1%); oral ulcers were the most frequent major symptom (97.5%) and the most common initial symptom (78.5%); erythema nodosum-like lesion (55.3%) was the most common type of skin lesion; a seasonal aggravation of the disease was observed in 21.3% of patients; and the most common type of childhood onset Behcet's disease was suspected type.
Adolescence ; Adult ; Age Distribution ; Aged ; Behcet's Syndrome/epidemiology* ; Behcet's Syndrome/complications ; Behcet's Syndrome/classification ; Child ; Female ; Human ; Korea/epidemiology ; Male ; Middle Age ; Sex Distribution

Recurrent aphthous stomatits (RAS) is also known as recurrent oral ulcers, recurrent aphthous ulcers, or simple or complex aphthosis. RAS is the most common inflammatory ulcerative condition of the oral mucosa in North American patients. RAS has been the subject of active investigation along multiple lines of research including epidemiology, immunology, clinical correlations and therapy. Clinical evaluation of the patient requires correct diagnosis of RAS and classification of the disease based on morphology (MIAU, MJAU, HU) and severity (simple versus complex). In order to properly diagnose and treat a patient with lesions of RAS, the clinician must exclude other causes of acute oral ulcers. Complex aphthosis and complex aphthosis variants associated with systemic disorders should be considered. The aphthous-like oral ulcerations of patients with HIV disease represent a challenging differential diagnosis. The association of lesions of RAS with hematinic deficiencies and gastrointestinal diseases provides an opportunity to identify a "correctable cause" which, with appropriate treatment, can result in a remission or substantial lessening of disease activity. Finally, when all of these factors are considered, the evaluation of the patient for Behcet's disease can be continued on firm grounds that one of the major criteria for the diagnosis of Behcet's disease has been met.
Behcet's Syndrome/diagnosis* ; Diagnosis, Differential ; Human ; Recurrence ; Stomatitis, Aphthous/etiology ; Stomatitis, Aphthous/diagnosis* ; Stomatitis, Aphthous/classification

There are no specific diagnostic laboratory tests for Behcet's disease. Diagnosis relies on proper history-taking and typical clinical manifestations. To provide more objectivity to the diagnosis, several diagnostic criteria have been introduced including one major set of guidelines by the International Study Group for Behcet's Disease (ISGBD) in 1990 which has made a significant contribution, although some disagreements exist in interpretation. Based on this criteria, recurrent oral ulceration is an obligatory manifestation for the diagnosis of Behcet's disease; however, some data indicates it is not a requirement for the diagnosis. In this article the author critically reviews different accepted diagnostic criteria or classifications of Behcet's disease and gives recommendations for a more thorough diagnosis.
Behcet's Syndrome/diagnosis* ; Behcet's Syndrome/classification ; Human

The intestinal lesion of Behcet's colitis shows aphthoid or punched-out ulceration. However, the diagnosis of Behcet's colitis should be based on the presence of other stigmata of Behcet's syndrome, since these morphological characteristics are not pathognomonic by themselves. Furthermore, the stigmata of Behcet's syndrome could appear simultaneously or separately with intervals of several months to years. Besides, when a physician first meets patients with intestinal ulcerations of aphthoid or punched-out shape, if they do not have any stigma of Behcet's syndrome, the physician has some difficulty in making a diagnosis of Behcet's colitis. The purpose of this retrospective study was to investigate the followings: 1) The upgrade in clinical type of Behcet's colitis with the advance of time. 2) What portion of the patients with aphthoid or punched-out ulcerations, but without any other clinical feature of Behcet's syndrome, could be diagnosed as Behcet's colitis with the advance of time? During the mean follow-up period of 38.2 months, 4 (22.2%) out of 18 patients with Behcet's colitis upgraded their clinical types. In the nonspecific ileocolitis group, who had no major stigma of Behcet's syndrome on their initial visit, 3 (30%) out of 10 patients were subsequently diagnosed as Behcet's colitis during the mean follow-up period of 33.3 months. From these results, we could conclude that in possible or suspicious cases of Behcet's colitis, a more confident diagnosis could be made by close observations for new developments of major stigma of Behcet's syndrome. Even in cases of nonspecific ileocolitis, the diagnosis of Behcet's colitis could be made in a significant number of cases as time goes by.
Adolescent ; Adult ; Behcet Syndrome/classification/*diagnosis/pathology ; Chi-Square Distribution ; Colitis, Ulcerative/*pathology ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Time Factors

To know the prognosis of Behcet's disease with HLA-Bw 51 antigen, comparison studies of 24 cases of Behcet's disease were investigated. The sex distribution was 14 males (58%) and 10 females (42%). The patients were grouped into three clinical types: the complete type with 11 cases (45%), the incomplete type with eight cases (33%) and the suspect type with five cases (22%), according to the criteria established by the Behcet's Disease Research Committee in Japan (1982). They were also divided into three ocular types according to the location of the inflammation: the anterior segment type, the fundus type and the mixed type. They were divided into 10%, 10% and 60% in HLA-Bw 51 negative group and 14%, 22% and 64% in HLA-Bw 51 positive group, respectively. Skin lesions observed in 30% of the HLA-Bw 51 negative group and 70% of the HLA-Bw 51 positive group, which was statistically significant (p < 0.01). The other general symptoms and the visual acuity between the two groups were not statistically significant (p > 0.1).
Adolescent ; Adult ; Behcet Syndrome/classification/*complications/immunology ; Eye Diseases/*etiology/immunology ; Female ; HLA-B Antigens/*analysis ; HLA-B51 Antigen ; Humans ; Male ; Middle Aged ; Prognosis ; Visual Acuity

For the purpose of epidemiologic study, the patients who visited Severance Hospital Behcet's Syndrome Specialty Clinic were grouped by Shimizu classification into the complete, incomplete, suspected types and evaluated. The results of the evaluation with respect to personal characteristics, geographic distribution, socioeconomic characteristics, family history, and clinical characteristics are as follows. 1. The incidence among the subgroups was incomplete type(46.3%), suspected type(36.7%), complete type(17.0%) and the male to female ratio was 0.60: 1, and the average age of onset was 29.1. years for males and 27.6 years for females. 2. The occupational distribution among males included office workers, 31.5%; drivers, 10.6% and among females was office workers, 6.7%; teachers, 3. 7 %; unemployed, 81.7%. 3. Among the presumed aggrevating factors affecting oral cavity, recurrent tonsillitis(20.8%) was most common, and premenstrual exacervation(12.8%) was most common. 4. The most common initial major manifestation was oral ulcer(80.6%), and the longest duration of major manifestations was oral ulcer(average 6.4 years), and the most frequent relapse of major manifestations was oral ulcer(average 14.6 times/year). 5. The average duration between the appearance of the first and second major manifestations was 5.2 years for complete type, 6.3 years for incomplete type, and 6.6 years for suspected type. 6. Combinations of major manifestations most commonly included oral ulcer, genital ulcers and skin lesions(65.3%) for incomplete type, and oral ulcer, skin lesion(54.8%) for suspected type.
Age of Onset ; Behcet Syndrome* ; Classification ; Epidemiologic Studies ; Family Characteristics ; Female ; Humans ; Incidence ; Male ; Mouth ; Oral Ulcer ; Recurrence ; Skin ; Ulcer