Computed tomography enterography increases the ability of endoscopy to differentiate Crohn's disease from intestinal Behçet's disease

Hong Yang; Huimin Zhang; Wei Liu; Wei Han; Tao Guo; Yamin Lai; Bei Tan; Congling Wang; Minhu Chen; Xiang Gao; Zhihua Ran; Zhanju Liu; Kaichun Wu; Qian Cao; Jiaming Qian

doi:10.3389/fmed.2022.900458

Computed tomography enterography increases the ability of endoscopy to differentiate Crohn's disease from intestinal Behçet's disease

Front Med (Lausanne). 2022 Aug 18:9:900458. doi: 10.3389/fmed.2022.900458. eCollection 2022.

Authors

Hong Yang¹, Huimin Zhang¹, Wei Liu², Wei Han³, Tao Guo¹, Yamin Lai¹, Bei Tan¹, Congling Wang¹, Minhu Chen⁴, Xiang Gao⁵, Zhihua Ran⁶, Zhanju Liu⁷, Kaichun Wu⁸, Qian Cao⁹, Jiaming Qian¹

Affiliations

¹ Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Radiology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences and Peking Union Medical College, Beijing, China.
³ Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, School of Basic Medicine, Beijing, China.
⁴ Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
⁵ Department of Gastroenterology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
⁶ Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Inflammatory Bowel Disease Research Center, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
⁷ Department of Gastroenterology, The Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.
⁸ State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
⁹ Department of Gastroenterology, Sir Run Run Shaw Hospital, College of Medicine Zhejiang University, Hangzhou, China.

Abstract

Background: Distinguishing Crohn's disease (CD) and intestinal Behçet's disease (BD) is difficult in clinical practice.

Aim: To evaluate the ability of CT enterography (CTE) to enhance the diagnostic value of endoscopy in differentiating CD from intestinal BD and to establish differential diagnosis models.

Methods: A total of 113 patients with CD and 70 patients with intestinal BD from seven tertiary inflammatory bowel disease centers were enrolled. The univariate and multivariate analyses were used by SAS software version 9.2. Three differential scoring models based on the multivariate analysis of endoscopic features alone (model 1), endoscopic features combined with clinical symptoms (model 2), and endoscopic features combined with clinical symptoms and CTE (model 3) were established.

Results: The results showed that model 2 increased the efficacy of model 1 in differential diagnosis and model 3 had the highest accuracy of 84.15% at a cutoff value of two points. The scoring of model 3 was as follows: genital ulcer (-3 points), skin lesions (-3 points), oval ulcer (-2 points), longitudinal ulcer (1 point), number of ulcers > 5 (3 points), inflammatory polyps (2 points), mucosal severe enhancement (2 points), and fibrofatty proliferation (1 point).

Conclusion: Clinical symptoms and CTE increased the ability of endoscopy to differentiate CD from intestinal BD.

Keywords: Behçet's disease; Crohn's disease; diagnosis; endoscopy; scoring model.