Endoscopic findings of gastrointestinal involvement in Chinese patients with Behcet's disease

AIM:To report the incidence,clinical features and outcomes of gastrointestinal(GI)involvement in Behcet’s disease(BD).METHODS:A total of 168 consecutive patients with BD were screened and upper and lower GI endoscopies were performed in 148 patients.Four hundred age-and sex-matched controls were enrolled for comparison.RESULTS:Fifty-two(35.1%)patients had GI lesions.After a mean follow-up of 10 mo,ileocecal ulcers had been confirmed in 20 patients,including active ulcer(s)in 18 patients,but no ileocecal ulceration was found in controls.GI symptoms were present in 14 patients with active ulcer(s),while 4 patients with smaller ulcer were asymptomatic.Endoscopic features of ileocecalulcer were:a single ulcer(50%),larger than 1 cm in diameter(72.2%),and round/oval or volcano-type in shape(83.3%).Compared with patients without GI involvement,less ocular lesions,lower levels of albumin,erythrocyte count and hemoglobin,and higher levels of C-reactive protein and erythrocyte sedimentation rate were confirmed in the intestinal BD group.Four patients had esophageal ulcers in the BD group but no case in controls.The other endoscopic findings were similar between the two groups.The prevalence of Helicobacter pylori infection was similar in both groups.Most patients received an immunomodulator and responded well.CONCLUSION:GI lesions commonly occur in Chinese BD patients.The most frequently involved area is the ileocecal region.Esophageal ulcer might be a rare but unique lesion.

Spontaneous aortic pseudoaneurysm rupture into the sigmoid colon in Behcet's disease patient

Beh?et's disease(BD) is a multisystem autoimmune disorder characterized by recurrent orogenital ulcers,uveitis,and skin lesions. The vascular manifestations include thrombophlebitis,stenosis,occlusion,and pseudoaneurysm. BD infrequently precipitates aortic pseudoaneurysm rupture into the sigmoid mesocolon and lumen of the adjacent colon. Here we report an extremely rare case of spontaneous abdominal aortic pseudoaneurysm rupture via the sigmoid mesocolon into the lumen of the sigmoid colon in a 37-year-old patient with BD.

Characteristic changes of intestinal flora and its correlation with clinical indexes in patients with Behcet's disease based on TCM syndromes

Objective: To analyze the characteristics of intestinal microflora in patients with Behcet's disease of damp heat syndrome by 16S rRNA technique and its correlation with clinical indexes;Methods: 49 patients with Behcet's disease were divided into Shire group (SR, n =19) and non-shire group (Non-SR, n = 30), and 43 healthy subjects were selected as control group. The basic information and laboratory test indexes of three groups were collected, and fecal samples were collected to detect the diversity and abundance of intestinal flora in each group by 16S rRNA. Results: Compared with Non-SR group, the incidence of ocular involvement was higher in SR group (P<0.05). At the same time, WBC, CRP, ESR and IgG in SR group were significantly higher than those in Non-SR group (P<0.05). The results of alpha diversity showed that the ace, Chao 1 and Shannon indexes of the SR group were significantly lower than those of the healthy group and the Non-SR group, while the Simpson index was significantly higher (P<0.05). Compared with the Non-SR group, the abundance of Actinobacteria phylum increased in the SR group (P<0.05);the level abundance of Collinsella, Intestinimonas and Enterobacteriaceae_ unclassified genus were increased, and the level abundance of Clostridiales_unclassified, Ruminococcaceae_UCG009, and Ruminococcus_gauvre auii_group genus were decreased (P<0.05). Pearson correlation analysis showed that Oscillospira abundance was positively correlated with WBC, CRP, ESR and IgG levels, while Eubacterium and Cetobacterium abundance were negatively correlated with WBC, CRP, ESR and IgG levels. Conclusion: The change of intestinal flora is involved in the pathogenesis of BD. At the same time, there are differences in intestinal flora in different types of BD patients. In addition, the specific flora in intestinal tract is closely related to the serum inflammation and immune indexes of BD.

Network pharmacology approach on the mechanism of Sanwu Huangqin Decoction in treating Behcet's disease

Objective:To analyze the main compounds of Sanwu Huangqin decoction based on the method of network pharmacology and to predict its possible target and mechanism of action in the treatment of Behcet's disease(BD).Methods:TCMSP,TCMID and literatures were used to search the main compounds and their corresponding targets of Sanwu Huangqin Decoction;the disease targets of BD were searched by GeneCards database;the intersection targets of Sanwu Huangqin Decoction and BD were visualized by String database and Cytoscape software;the intersection targets were enriched by GO and KEGG by DAVID database;BD mouse model was established,RT-PCR was used to verify the regulatory effect of Sanwu Huangqin Decoction on the core target genes.Results:A total of 81 main active compounds and 50 drug-disease-target were retrieved from the databases.There were 531 biological function information and 96 signal pathways were enriched by GO and KEGG.Among them,the top 5 signal pathways were Fluid shear stress and atherosclerosis、AGE-RAGE signaling pathway in diabetic complications、IL-17 signaling pathway、TNF signaling pathway、Malaria、Chagas disease(American trypanosomiasis).RT-PCR results showed that the expression of IL-4,IL-1β,IL-6,INF-γmRNA in the spleen of BD mice was significantly up-regulated,and the expression of Caspase 3 and Caspase 8 mRNA was significantly down regulated when compared with the control group(P<0.01).Compared with the model group,the expression of IL-4,IL-1β,IL-6,INF-γmRNA in the Sanwu Huangqin decoction group was significantly down regulated,and the expression of caspase 3 and caspase 8 mRNA was significantly up regulated(P<0.01).Conclusion:Sanwu Huangqin decoction can treat BD through multi-target and multi-channel therapy,and our study and our research provides bioinformatics basis for further revealing its mechanism and treatment.

Effect of Sanwu Huangqin Decoction on IFN-γ and IL-17A levels in mice with Behcet's disease

Objective:To investigate the effect of Sanwu Huangqin Decoction on IFN-γand IL-17A levels in mice with Behcet's disease;Methods:Clinical samples of patients with Behcet's disease were collected and mononuclear cells were isolated.High throughput RNA-seq was used to identify the different genes between Behcet's disease and healthy subjects.Mouse model was constructed by shrimp myosin sensitization and treated with Sanwu Huangqin decoction.The levels of IFN-γand IL-17A in peripheral blood and mononuclear cells were detected by ELISA and flow cytometry.The expression level of TBX21 gene in spleen was detected by RT-PCR;Results:Compared with healthy subjects,31 differential genes were identified in BD patients,of which 19 genes were up-regulated and 12 genes were down regulated.PPI analysis showed that the top 5 genes were TBX21,STAT3,IL15,PRF1 and IFNG.The results of animal experiments showed that the levels of IFN-γand IL-17A in the peripheral blood and PBMC of the model group were significantly higher compared with the control group(P<0.01).Sanwu Huangqin decoction could significantly reduce the levels of IFN-γand IL-17A in the peripheral blood and PBMC of mice(P<0.05 or P<0.01).RT-PCR results showed that the expression of TBX21 mRNA in spleen tissue of model group was significantly higher than that of the control group(P<0.01).Sanwu Huangqin decoction could significantly down-regulate the expression of TBX21 mRNA in spleen(P<0.05 or P<0.01);Conclusion:Sanwu Huangqin decoction reduce the levels of IFN-γand IL-17A by inhibiting the expression of TBX21 mRNA,so as to achieve the effect of treating BD.

Amyloidosis with recurrent oral and peptic ulcers mimicking Behcet's syndrome:A case report

Introduction:Amyloidosis and Behcet's syndrome(BS)are systemic diseases that affect multiple systems.Similar mucocutaneous damage occurs in amyloidosis and BS,thus causing a delayed or incorrect diagnosis.The prognosis of patients with amyloidosis is poor.Therefore,exclusion of other diagnoses is important before confirming the presence of BS.Case Report:We report a case of a 43-year-old woman who initially presented with peptic ulcers,recurrent oral ulcers,and suspicious genital ulcers resembling BS.She was treated with systemic steroids at the local hospital for approximately 2 years.However,her symptoms were not relieved,and the gradual presence of macroglossia,hoarseness,periorbital purpura,proteinuria,and cardiac involvement strongly suggested amyloidosis.She was diagnosed with immunoglobulin light chain amyloidosis(lambda type)after extensive examinations,including an elevated monoclonal protein concentration,Congo red staining,and immunohistochemical staining of abdominal fat.She was then treated with a chemotherapy regimen(melphalan and dexamethasone).Conclusion:Recurrent oral ulcers can be the first manifestation of amyloidosis.The diagnosis of BS requires the exclusion of other diseases,and amyloidosis should be considered as a differential diagnosis.

Anaplastic lymphoma kinase-negative anaplastic large cell lymphoma masquerading as Behcet’s disease: A case report and review of literature

BACKGROUND Anaplastic large cell lymphoma(ALCL)is a CD30-positive T cell lymphoma,a rare type of non-Hodgkin lymphoma.The current World Health Organization classification system divides ALCLs into anaplastic lymphoma kinase(ALK)-positive and ALK-negative groups.ALCL rarely presents in the gastrointestinal tract.CASE SUMMARY A 54-year-old male was admitted to the department of gastroenterology for abdominal pain.He presented with lower abdominal pain,diarrhea and recurrent oral and penile ulcers.He was misdiagnosed with Behcet's disease and treated with prednisone.But after one month,he was hospitalized in another hospital for reexamination.This time,the lesion on the penis was biopsied for histological examination.The final pathological diagnosis was ALCL,ALKnegative.The patient was treated with cyclophosphamide,doxorubicin,vincristine,prednisolone chemotherapy.However,he died within one month.CONCLUSION Gastrointestinal ALCL needs to be considered in the differential diagnosis to avoid delaying treatment.Repeated biopsy is the most important for early diagnosis and treatment.

Behcet’s disease manifesting as esophageal variceal bleeding: A case report

BACKGROUND Behcet’s disease(BD)is a chronic disease characterized by oral and vulvar ulcers as well as eye and skin damage and involves multiple systems.It presents as an alternating process of repeated attacks and remissions.Esophageal venous rupture and bleeding caused by BD is rarely reported at home and abroad.This paper reports a case of bleeding from oesophageal varices caused by BD,aiming to provide an additional dimension for considering the cause of bleeding from esophageal varices in the future.CASE SUMMARY A 38-year-old female patient was admitted due to a gradual increase in shortness of breath and chest tightness after the activity,and was admitted to our hospital for treatment.After admission,relevant examinations showed that the patient had multiple blood clots.Four days after admission,she suddenly experienced massive hematemesis.Emergency esophagogastroduodenoscopy revealed bleeding from esophageal and gastric varices.The patient had no history of viral hepatitis or drinking habits,and no history of special genetic diseases or congenital vascular diseases.There is no obvious abnormality in liver function.After reviewing the medical history,it was found that the patient had recurred oral ulcers since childhood,ulcers were visible in the perineum during menstruation,and there was an intermittent red nodular rash and uveitis.The current skin acupuncture reaction is positive,combined with the evaluation of the external hospital and our hospital,the main diagnosis is BD.She received methylprednisolone,cyclophosphamide,immunomodulation,acid suppression,gastric protection,and anticoagulation and anti-infection treatments,and was discharged from the hospital.During the 1-year follow-up period,the patient did not vomit blood again.CONCLUSION This case highlights bleeding from esophageal varices caused by BD, aiming toprovide an additional dimension concerning the cause of bleeding fromesophageal varices in the future.