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Rheumatology Advance Access published online on June 11, 2008
Rheumatology, doi:10.1093/rheumatology/ken216
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Wireless capsule endoscopy in the investigation of intestinal Behçet's syndrome

S. S. Hamdulay1, K. Cheent2, C. Ghosh2, J. Stocks2, S. Ghosh2 and D. O. Haskard1

1National Heart and Lung Institute and 2Department of Gastroenterology, Hammersmith Campus, Imperial College, London, UK.

Correspondence to: D. O. Haskard, National Heart and Lung Institute, Hammersmith Campus, Imperial College, Du Cane Road, London W12 ONN, UK. E-mail: d.haskard{at}imperial.ac.uk


  Abstract

Objective. Intestinal Behçet's Syndrome (BS) is a difficult diagnosis to establish. We describe the use of wireless capsule endoscopy (WCE) in the investigation of 11 patients with suspected intestinal BS.

Methods. Out of 11 patients, 10 with suspected intestinal BS were found to have small intestinal ulcers on capsule endoscopy. Each case was retrospectively assessed for symptoms, signs, anaemia, other investigations, treatment and complications.

Results. All 11 patients had established diagnoses of BS as defined by the International Study Group criteria. Central abdominal pain and change in bowel habit were the predominant symptoms, both occurring in seven patients. Upper gastrointestinal (GI) endoscopy and colonoscopy identified duodenitis, ileitis and colitis in three patients. Barium studies and CT were normal in all cases. WCE revealed small intestinal ulcers throughout the ileum in five patients and ulcers located either in the proximal and/or distal ileum in five other patients. One patient had significant symptoms, signs and ulcers leading to a change in treatment to infliximab, and this resulted in resolution of symptoms and ulcers. Ten age- and sex-matched controls investigated for unexplained GI symptoms had no intestinal lesions on capsule endoscopy.

Conclusion. WCE is useful in the investigation of GI symptoms in BS. It is particularly helpful in those patients in whom conventional investigations have been normal or fail to account for symptoms and signs. This technique may guide treatment and provide a better understanding of intestinal pathology in BS.

KEY WORDS: Behçet's syndrome, Intestine, Wireless capsule endoscopy

Submitted 31 December 2007; revised version accepted 9 May 2008.
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