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Copyright ©2014 Baishideng Publishing Group Inc.
World J Gastrointest Pathophysiol. Aug 15, 2014; 5(3): 228-238
Published online Aug 15, 2014. doi: 10.4291/wjgp.v5.i3.228
Table 1 Diagnostic criteria for Behçet’s disease and Crohn’s disease
International Study Group Diagnostic Criteria for Behçet’s disease[70]Proposed diagnostic criteria for Crohn’s disease
Japan Criteria[72]Lennard-Jones Criteria[73]Copenhagen Criteria[8]
Major findingsRecurrent oral ulcerationsA: Longitudinal ulcer B: Cobblestone-like appearance C: Noncaseating epithelioid cell granulomaTypical diarrhea history for at least 2 mo; 1 Radiological features of CD: segmental distribution, deep ulcerations or cobblestone pattern, thickened bowel wall, coarse mucosal relief, stenotic segments and fistulae; 2 Macroscopic diagnosis by endoscopy: patchy penetrating lesions, fissuring and strictures 3 Fistulas and/or abscesses with typical intestinal disease1 History of abdominal pain, weight loss and/or diarrhea for more than 3 mo 2 Characteristic endoscopic findings of ulceration (aphtous lesions, snail track ulceration) or cobble stoning or radiological features of stricture or cobble stoning 3 Histopathology consistent with Crohn’s disease (epitheloid granuloma of Langerhans type or transmural discontinuous focal or patchy inflammation) 4 Fistula and/or abscess in relation to affected bowel segments
Minor findingsRecurrent genital ulcerations Eye lesions Skin lesions Positive pathergy test(1) Irregular-shaped and/or quasi-circular ulcers or aphthous ulcerations found extensively in the gastrointestinal tract (2) Characteristic perianal lesions (3) Characteristic gastric and/or duodenal lesions
DefiniteMajor finding plus two minor findings1 Major finding A or B 2 Major finding C, with minor finding (1) or (2) 3 All minor findings (1), (2), and (3)Positive findings or one positive plus the finding of granulomaAt least two of the criteria present
Table 2 Treatment options for Behçet’s and Crohn’s disease
BD
CD
Extraintestinal BDIntestinal BDExtraintestinal CDIntestinal CD
ColchicineS, M, A---
CorticosteroidsAll manifestations+All manifestations+
AzathioprineS, M, O, V, N+S+
6-mercaptopurine-??-+
Cyclosporine AO---
Interferon-alphaO, N---
Mycophenolate MofetilO---
CyclophosphamideO, V, N---
MethotrexateA, N-A, S-
SulfasalazineA+A+
Mesalazine-+-+
Anti-TNF agentsA, O, N+A, S, O+
Table 3 Distribution of similarities and differences in the differential diagnosis of Behçet’s disease and Crohn’s disease[2,3,6,8,9,14,58,60,62,68,81]
Behçet’s DiseaseCrohn’s Disease
Gender (M/F)4.9-0.572.9-0.76
Symptoms onset age (yr)20.8-4015-29
Average age at diagnosis (yr)24.7-35.729.5-31
Oral aphtous ulcers (%)Approximately 100< 10
Uveitis (%)57-69< 10
Skin lesions (%)61-87< 10
Arthritis (%)30-572-24.7
Gastrointestinal involvement (%)
Ileocecal area50-9440-83
Colon10-1532-50
Upper GI1-34
Perianal1-210-15
Intestinal complications (%)
Perforation12.78.7
Fistula7.624.7
Stricture7.238.3
Abscess3.319.6
Endoscopic MorphologyRound-oval shape,Longitudinal ulcers with a cobblestone appearance
Focal, solitary(segmental and diffuse distribution)
Volcano-shaped
Deep ulcers
Mucosal BiopsyVasculitisGranuloma
Neutrophilic infiltrationFocal cryptitis
Fibrinopurulent exudatesNerve fiberhyperplasia
Necrotic debrisLymphoid aggregates