Published online Jun 6, 2021. doi: 10.12998/wjcc.v9.i16.3858
Peer-review started: November 30, 2020
First decision: February 23, 2021
Revised: March 1, 2021
Accepted: April 6, 2021
Article in press: April 6, 2021
Published online: June 6, 2021
Processing time: 163 Days and 6.2 Hours
Gastrointestinal involvement in Behçet's disease (GIBD) and Crohn’s disease (CD) are inflammatory diseases sharing a considerable number of similarities. However, different from CD, the operative and postoperative management of GIBD remains largely empirical because of the lack of comprehensive treatment guidelines.
To compare surgical patients with GIBD and those with CD in a medical center and identify notable clinical features and effective postoperative treatment for surgical patients with GIBD.
We searched patients diagnosed with CD and GIBD who underwent operations for gastrointestinal complications from 2009 to 2015 at West China Hospital of Sichuan University. A total of 10 surgical patients with GIBD and 106 surgical patients with CD were recruited. Information including demographic data, medication, and operative and postoperative parameters were collected and analyzed. As the incidence of surgical GIBD is low, their detailed medical records were reviewed and compared to previous studies. Moreover, the prognoses of CD and GIBD were evaluated respectively between groups treated with biological and non-biological agents.
Indication for first surgery was often acute intestinal perforation for GIBD patients (7/10 vs 0/106, P < 0.001), whereas intestinal fistulae (0/10 vs 44/106, P = 0.013) and ileus (0/10 vs 40/106, P = 0.015) were the indications for surgical CD patients. Approximately 40% of patients with GIBD and 23.6% of patients with CD developed postoperative complications, 50% of patients with GIBD and 38.7% of patients with CD had recurrence postoperatively, and 40% (4/10) of patients with GIBD and 26.4% (28/106) of patients with CD underwent reoperations. The average period of postoperative recurrence was 7.87 mo in patients with Behçet's disease (BD) and 10.43 mo in patients with CD, whereas the mean duration from first surgery to reoperation was 5.75 mo in BD patients and 18.04 mo in CD patients. Surgical patients with GIBD more often used corticosteroids (6/10 vs 7/106, P < 0.001) and thalidomide (7/10 vs 9/106, P < 0.001) postoperatively, whereas surgical patients with CD often used infliximab (27/106), azathioprine, or 6-mercaptopurine (74/106) for maintenance therapy.
Patients suffering GIBD require surgery mostly under emergency situations, which may be more susceptible to recurrence and reoperation and need more aggressive postoperative treatment than patients with CD.
Core Tip: This real-world study was designed to identify effective postoperative treatment for patients with gastrointestinal involvement in Behçet's disease (GIBD) from the experience of Crohn’s disease (CD). Indication for first surgery was often acute gastrointestinal complications for GIBD patients, compared with patients with CD frequently undergoing purposed elective surgeries. Although no statistically significant difference was observed, patients with GIBD suffered more and earlier recurrences and reoperations than patients with CD. Awareness should be raised about the emergency condition of GIBD because it is more likely to be discounted than CD in clinics. Furthermore, they may require more aggressive treatment for more severe disease process postoperatively, like biological agents.