Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Oct 28, 2012; 18(40): 5771-5778
Published online Oct 28, 2012. doi: 10.3748/wjg.v18.i40.5771
Correlations between endoscopic and clinical disease activity indices in intestinal Behcet's disease
Hyun Jung Lee, Youn Nam Kim, Hui Won Jang, Han Ho Jeon, Eun Suk Jung, Soo Jung Park, Sung Pil Hong, Tae Il Kim, Won Ho Kim, Chung Mo Nam, Jae Hee Cheon
Hyun Jung Lee, Hui Won Jang, Han Ho Jeon, Eun Suk Jung, Soo Jung Park, Sung Pil Hong, Tae Il Kim, Won Ho Kim, Jae Hee Cheon, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea
Youn Nam Kim, Department of Biostatistics, Yonsei University College of Medicine, Seoul 120-752, South Korea
Chung Mo Nam, Department of Preventive Medicine, Yonsei University College of Medicine, Seoul 120-752, South Korea
Author contributions: Lee HJ performed the data analysis and wrote the manuscript; Cheon JH had original idea on this subject, performed colonoscopy, performed the data analysis and wrote the manuscript; Jang HW, Jeon HH, Jung ES, Park SJ, Hong SP, Kim TI and Kim WH performed colonoscopy and reviewed the manuscript critically; Kim YN and Nam CM performed the statistical analysis and reviewed the manuscript.
Correspondence to: Jae Hee Cheon, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea. geniushee@yuhs.ac
Telephone: +82-2-22281990 Fax: +82-2-3936884
Received: May 11, 2012
Revised: July 4, 2012
Accepted: July 18, 2012
Published online: October 28, 2012
Abstract

AIM: To develop a novel endoscopic severity model of intestinal Behcet's disease (BD) and to evaluate its feasibility by comparing it with the actual disease activity index for intestinal Behcet's disease (DAIBD).

METHODS: We reviewed the medical records of 167 intestinal BD patients between March 1986 and April 2011. We also investigated the endoscopic parameters including ulcer locations, distribution, number, depth, shape, size and margin to identify independent factors associated with DAIBD. An endoscopic severity model was developed using significant colonoscopic variables identified by multivariate regression analysis and its correlation with the DAIBD was evaluated. To determine factors related to the discrepancy between endoscopic severity and clinical activity, clinical characteristics and laboratory markers of the patients were analyzed.

RESULTS: A multivariate regression analysis revealed that the number of intestinal ulcers (≥ 2, P = 0.031) and volcanoshaped ulcers (P = 0.001) were predictive factors for the DAIBD. An endoscopic severity model (Y) was developed based on selected endoscopic variables as follows: Y = 47.44 + 9.04 × non-Ileocecal area + 11.85 ×≥ 2 of intestinal ulcers + 5.03 × shallow ulcers + 12.76 × deep ulcers + 4.47 × geographic-shaped ulcers + 26.93 × volcano-shaped ulcers + 8.65 ×≥ 20 mm of intestinal ulcers. However, endoscopic parameters used in the multivariate analysis explained only 18.9% of the DAIBD variance. Patients with severe DAIBD scores but with moderately predicted disease activity by the endoscopic severity model had more symptoms of irritable bowel syndrome (21.4% vs 4.9%, P = 0.026) and a lower rate of corticosteroid use (50.0% vs 75.6%, P = 0.016) than those with severe DAIBD scores and accurately predicted disease by the model.

CONCLUSION: Our study showed that the number of intestinal ulcers and volcano-shaped ulcers were predictive factors for severe DAIBD scores. However, the correlation between endoscopic severity and DAIBD (r = 0.434) was weak.

Keywords: Intestinal Behcet's disease; Disease activity index; Colonoscopy; Ulcer; Endoscopic severity