Management and outcomes of surgical patients with intestinal Behçet’s disease and Crohn’s disease in southwest China

Table 1 Clinical features of surgical patients with gastrointestinal involvement in Behçet's disease and Crohn’s disease

	GIBD (n = 10)	CD (n = 106)	P value
Age (mean ± SD)	41.90 ± 11.15	32.38 ± 9.46	0.003
Male, n (%)	6 (60)	74 (69.8)	0.498
Family history (n)	0	0	——
Symptoms and signs, n (%)
Oral aphthae	8 (80)	8 (7.5)	< 0.001
Ocular lesion	1 (10)	0	0.086
Genital ulcer	5 (50)	3 (2.8)	< 0.001
Skin lesion	5 (50)	2 (1.9)	< 0.001
Arthritis/arthralgia	4 (40)	16 (15.1)	0.068
Abdominal pain	10(100)	101 (95.3)	1.000
Diarrhea	2 (20)	67 (63.2)	< 0.014
GI bleeding	6 (60)	37 (34.9)	0.170
Abdominal mass	3 (30)	39 (36.8)	0.746
Fever	6 (60)	26 (24.5)	0.026
Weight loss	6 (60)	74 (69.8)	0.498
Location of ulcer, n (%)
Upper GI	0	2 (1.8)	1.000
Ileum/jejunum	1 (10)	16 (15.1)	1.000
Ileum and ileocecal	2 (20)	3 (2.8)	0.058
Ileum and colon	4 (40)	66 (62.3)	0.191
Colon	3 (30)	19 (17.9)	0.377
Shape of ulcer, n (%)
Oval	4 (40)	0	< 0.001
Longitudinal	0	38 (35.8)	0.029
Other	6 (60)	68 (64.2)	1.000

CD: Crohn’s disease; GIBD: Gastrointestinal involvement in Behçet's disease; GI: Gastrointestinal; SD: Standard deviation.

Table 2 Surgery and postoperative parameters of patients with gastrointestinal involvement in Behçet's disease and Crohn’s disease

	GIBD (n = 10)	CD (n = 106)	P value
Diagnosed after first surgery, n (%)	7 (70.0)	56 (52.8)	0.341
Duration from initial diagnosis to first surgery (mo, mean ± SD)	27.67 ± 23.03(n = 3)1	41.60 ± 39.22(n = 50)2	0.548
Indications for first surgery, n (%)
Perianal abscess or fistula	0	10 (9.4)	0.597
Intestinal fistulae	0	44 (41.5)	0.013
Ileus	0	40 (37.7)	0.015
Abdominal abscess	0	12 (11.3)	0.596
Acute intestinal perforation	7 (70)	0	< 0.001
Diagnostic surgery for acute abdomen	3 (30)	0	< 0.001
First operation type, n (%)
Segmental resection and ostomy	7 (70)	48 (45.3)	0.188
Perforation repairmen + drainage	1 (10)	0	0.086
Segmental resection	2 (20)	37 (34.9)	1.000
Drainage	0	21 (19.8)	0.204
Others	0	1 (0.9)	1.000
Ostomy closure, n (%)	5 (71.4)3	29 (60.4)4	0.696
Ostomy to ostomy closure (mo, mean ± SD)	18.60 ± 10.14	13.86 ± 10.58	0.359
Recurrence, n (%)	5 (50)	41 (38.7)	0.515
Recurrence from first surgery (mo, mean ± SD)	7.87 ± 7.37	10.43 ± 8.97	0.543
Recurrence location, n (%)
Anastomosis	5 (100)	32 (78.8)	0.566
Others	2 (40)	26 (63.4)	0.365
Reoperations, n (%)	4 (40)	28 (26.4)	0.460
Duration from first surgery to reoperation (mo, mean ± SD)	5.75 ± 4.99	18.04 ± 16.30	0.150
Postoperative complications, n (%)	4 (40)	25 (23.6)	0.265
GI bleeding	1 (10)	5 (4.7)	0.425
Anastomotic fistula	2 (20)	23 (21.7)	1.000
Intraabdominal infection	4 (40)	12 (11.3)	0.031
Others	1 (10)	4 (3.8)	0.368
Mortality, n (%)	1 (10)	2 (1.9)	0.239

Patients with gastrointestinal involvement in Behçet's disease (GIBD) required surgery always for acute and emergency complications, while elective surgeries were more common in patients with Crohn’s disease (CD). The average period of postoperative recurrence was 7.87 mo with a range of 0.3 to 18 mo in GIBD patients and 10.43 mo with a range of 2 to 36 mo in CD patients.

¹Three (30.0) patients with GIBD were diagnosed before first surgery.

²Fifty (47.2) patients with CD were diagnosed before first surgery.

³Seven (70.0) patients with GIBD underwent surgery including the operation type of ostomy.

⁴Forty-eight (45.3) patients with CD underwent surgery including the operation type of ostomy. CD: Crohn’s disease; GIBD: Gastrointestinal involvement in Behçet's disease; SD: Standard deviation.

Table 3 Use of drugs before and after surgery in patients with gastrointestinal involvement in Behçet's disease and Crohn’s disease

	GIBD (n = 10)			CD (n = 106)		P value
	Before surgery (n = 3)1	After surgery (n = 10)	Before surgery (n = 50)2		After surgery (n = 106)	P1 value	P2 value
5-ASA or sulfasalazine	1(33.3)	1 (10)	31 (62)		12 (11.3)	0.555	1.000
AZA or 6-MP	1(33.3)	6 (60)	20 (40)		74 (69.8)	1.000	0.498
Corticosteroids	0	6 (60)	7 (14)		7 (6.6)	1.000	< 0.001
Biological agent	0	2 (20)	9 (18)		27 (25.5)	1.000	1.000
Infliximab	0	0	9 (18)		27 (25.5)	1.000	0.114
Adalimumab	0	2 (20)	0		0	-	0.007
Thalidomide	1(33.3)	7 (70)	2 (4)		9 (8.5)	0.163	< 0.001
MTX	0	0	1 (2)		2 (1.9)	1.000	1.000
Others	0	1 (10)	1 (2)		2 (1.9)	1.000	0.239

¹Three (30.0) surgical patients with gastrointestinal involvement in Behçet's disease were diagnosed before first surgery.

²Fifty (45.0) surgical patients with Crohn’s disease were diagnosed before first surgery. CD: Crohn’s disease; GIBD: Gastrointestinal involvement in Behçet's disease; 5-ASA: 5-aminosallcylic acid; 6-MP: 6-mercaptopurine; AZA: Azathioprine; MTX: Methotrexate.