Ulcerative colitis followed by the development of typical intestinal Behçet disease: A case report

[Intestinal manifestations of Behçet's disease]

Behçet's disease (BD) is a systemic vasculitis of unknown origin, characterized by recurrences of the ulcerative process in the oral cavity and on the genitals, inflammatory damage of the eyes, joints, vessels and other organs. The severity and prognosis of BD determines organ pathology. Intestinal manifestations of BD (intestinal BD) are the least studied. Its verification in BD is complicated by the variety of clinical manifestations, their similarity with inflammatory bowel diseases, the lack of informative laboratory tests, pathognomonic endoscopic and histological signs. Intestinal BD can lead to serious complications (massive bleeding, intestinal perforation and fistula formation), which can not only significantly reduce the quality of the patient's life, but also cause death. Treatment of intestinal BD is not standardized; it is mainly empirical and conducted courses. The purpose of therapy is to achieve clinical remission, healing of intestinal ulcers and prevention of surgery. The article presents a case of severe refractory intestinal BD, requiring twice emergency surgical care - removal of half and then the whole of the colon because of multiple perforations. A brief review of the literature is given and diagnostic difficulties of intestinal BD are discussed.

Clinical Significance of Serum Bilirubin in Behçet's Disease

Background and Objective

Bilirubin (Bb) is the product of the intravascular compartment of catabolic pathway. In a small number of clinical trials, it has been shown that Bb molecules are associated with cardiovascular diseases, diabetes, cancer, autoimmune (lupus, rheumatoid arthritis) diseases and schizophrenia. Behçet's disease is a chronic, multisystemic, inflammatory vasculitis that was first described by Hulusi Behçet in 1937, which affects almost all organs and systems without any known aetiology. Here, we investigated the clinical significance of serum Bb as a biomarker in the patients with Behçet's disease.

Methods

Seventy-one (N = 71) patients with Behcet's diagnosis within the last 1 year were included retrospectively. Control group consisted of 75 subjects with similar age and sex distribution. Serum Bb, indirect Bb, total Bb, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) data were recorded from the hospital records.

Results

In the Behçet group, direct Bb was significantly lower (P = 0.011), ESR and CRP were significantly higher (P = 0.00). No significant differences were observed in other parameters. In the whole group, total Bb and indirect Bb were negatively correlated with ESR (P = 0.025, P = 0.01). Direct Bb was negatively correlated with CRP (P = 0.002). For the diagnosis of Behçet, direct Bb with a threshold of < 0.14 can be used as a diagnostic test (P = 0.000) with 70% sensitivity, 68% specificity (area under the curve = 0.69; 95% confidence interval 0.59–0.80) in ROC curve analysis.

Conclusion

According to our study, we found that inflammatory markers were high and direct Bb values were low in patients with Behcet's disease. In addition, Bb parameters were negatively associated with acute phase reactants. As a practical biomarker with anti-oxidative properties, the direct Bb can be used to diagnose and clinical follow-up in cases with Behçet's disease.

Bacillus subtilis and Enterococcus faecium enteric-coated capsules combined with mesalazine for treatment of patients with ulcerative colitis: Efficacy and impact on serum levels of SOD, MDA, interleukins, and TNF-α

AIM

To observe the curative effect of Bacillus subtilis and Enterococcus faecium enteric-coated capsules and mesalazine in patients with ulcerative colitis and their impact on serum levels of interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor α (TNF-α), malondialdehyde (MDA), superoxide dismutase (SOD), cyclooxygenase-2 (COX-2), and nuclear factor-κB (NF-κB).

METHODS

Eighty-six patients with ulcerative colitis admitted to our hospital from August 2014 to November 2016 were selected and randomly divided into an observation group and a control group, with 43 cases in each group. Both groups were given mesalazine enteric-coated tablets, and the observation group was additionally given Bacillus subtilis and Enterococcus faecium enteric-coated capsules. After continuous treatment for 2 mo, the clinical curative effect, time to symptom relief, Rachmitewitz score, and Sutherland score were recorded. Serum levels of IL-6, IL-8, IL-10, TNF-α, MDA, SOD), COX-2, and NF-κB were measured. The patients were followed for 6 mo to record the recurrence.

RESULTS

The total effective rate in the observation group was 93.02%, which was significantly higher than that in the control group (76.74%; Z = 4.440, P = 0.035). The time to relief of symptoms such as diarrhea, abdominal pain, and mucus and blood in stool was significantly shorter in the observation group than in the control group (P < 0.05). After treatment, Rachmitewitz and Sutherland scores of both groups decreased significantly compared with those before treatment, and the scores of the observation group were significantly lower than those of the control group (P < 0.05). After treatment, the levels of IL-6, IL-8, and TNF-α in the observation group were significantly lower and that of IL-10 was significantly higher in the observation group than in the control group (P < 0.05). Moreover, the levels of MDA, COX-2, and NF-κB were significantly lower and that of SOD was significantly higher in the observation group than in the control group (P < 0.05). During a follow-up period of 6 months, the recurrence rate was lower in the observation group than in the control group (11.63% vs 16.28%).

CONCLUSION

Bacillus subtilis and Enterococcus faecium enteric-coated capsules combined with mesalazine is better than mesalazine alone in reducing clinical symptoms and improving serum levels of inflammatory cytokines and oxidative stress in patients with ulcerative colitis, with no significant effect on long-term recurrence.