Temporal changes in the clinical type or diagnosis of Behçet's colitis in patients with aphthoid or punched-out colonic ulcerations.

The intestinal lesion of Behçet's colitis shows aphthoid or punched-out ulceration. However, the diagnosis of Behçet's colitis should be based on the presence of other stigmata of Behçet's syndrome, since these morphological characteristics are not pathognomonic by themselves. Furthermore, the stigmata of Behçet's syndrome could appear simultaneously or separately with intervals of several months to years. Besides, when a physician first meets patients with intestinal ulcerations of aphthoid or punched-out shape, if they do not have any stigma of Behçet's syndrome, the physician has some difficulty in making a diagnosis of Behçet's colitis. The purpose of this retrospective study was to investigate the followings: 1) The upgrade in clinical type of Behçet's colitis with the advance of time. 2) What portion of the patients with aphthoid or punched-out ulcerations, but without any other clinical feature of Behçet's syndrome, could be diagnosed as Behçet's colitis with the advance of time? During the mean follow-up period of 38.2 months, 4 (22.2%) out of 18 patients with Behçet's colitis upgraded their clinical types. In the nonspecific ileocolitis group, who had no major stigma of Behçet's syndrome on their initial visit, 3 (30%) out of 10 patients were subsequently diagnosed as Behçet's colitis during the mean follow-up period of 33.3 months. From these results, we could conclude that in possible or suspicious cases of Behçet's colitis, a more confident diagnosis could be made by close observations for new developments of major stigma of Behçet's syndrome. Even in cases of nonspecific ileocolitis, the diagnosis of Behçet's colitis could be made in a significant number of cases as time goes by.