Development and Validation of Novel Diagnostic Criteria for Intestinal Behet's Disease in Korean Patients With Ileocolonic Ulcers

Abstract

OBJECTIVES: It is diffi cult to diagnose intestinal Beh ç et ’ s disease (BD) due to various extraintestinal manifestations emerging at different time points in the disease course and a lack of reliable diagnostic criteria. We conducted this study to develop and validate novel diagnostic criteria for intestinal BD. METHODS: Experts from three universities generated the preliminary diagnostic criteria for intestinal BD, and a consensus was reached using a modifi ed Delphi method with 13 gastroenterologists participating. To validate the criteria, we recruited 12,850 consecutive patients who underwent colonoscopic examinations between January 2000 and December 2006 at Severance Hospital, Yonsei University, Seoul, Korea. RESULTS: The novel diagnostic criteria were developed on the basis of two aspects: colonoscopic fi ndings and extraintestinal manifestations. Of the 12,850 patients, 280 with ileocolonic ulcers were enrolled for validation. At the time of initial colonoscopic examinations, patients were categorized for BD status into 4 groups: defi nite (84 patients), probable (67), suspected (15), and nondiagnostic (114). At the end of the follow-up period (mean, 50.9 ± 25.7 months), intestinal BD was confi rmed in 145 patients (51.8 % ) — 84 (100 % ) from the defi nite group, 49 (73.1 % ) from the probable group, 10 (66.7 % ) from the suspected group, and 2 (1.8 % ) from the nondiagnostic group. The overall sensitivity, specifi city, positive predictive value, negative predictive value, and accuracy of the diagnosis probability of these criteria were 98.6, 83.0, 86.1, 98.2, and 91.1 % , respectively. CONCLUSIONS: These newly proposed, simple criteria might be useful in diagnosing intestinal BD, especially in patients with ileocolonic ulcers who do not fully satisfy the diagnostic criteria of systemic BD.