A Multicenter Observational Study for the Establishment of Novel Severity Criteria Including Endoscopic Evaluation for Intestinal Behçet's Disease.

Objective: This study aimed to establish a novel severity classification for intestinal Behçet's disease (BD) (SCIBD) and validate its criteria across multiple institutions.

Methods: Five parameters, including abdominal pain, tenderness, intestinal bleeding, serum C-reactive protein (CRP) level, and endoscopic findings, were identified to assess the severity of intestinal BD. Disease severity was categorized into remission and mild, moderate, or severe disease based on the criteria of each factor. This study also evaluated the correlation among the SCIBD scale, serum biomarkers, former disease activity for intestinal BD (DAIBD), and treatment decisions.

Results: A total of 146 patients with intestinal BD and simple ulcers were retrospectively enrolled from 14 institutions between April and November 2022. As SCIBD severity increased, CRP and DAIBD levels significantly increased, whereas serum albumin levels decreased in the whole population. Similar correlations have been observed even in patients with intestinal BD. Antitumor necrosis factor-alpha treatment was also significantly more common in severe cases (49.4%) than in moderate cases (20.8%; p = 0.001). However, the proportion of patients requiring corticosteroids was comparable between the moderate and severe disease groups (39.6% vs. 33.3%). In addition, no significant differences were observed in the frequency of corticosteroid treatment, anti-TNF-α treatment, or surgery among the four groups: quiescent, mild, moderate, and severe cases of DAIBD. SCIBD was changed after treatment with corticosteroids and TNF-α according to improving clinical, biological, and endoscopic findings.

Conclusions: The severity assessment of intestinal BD using our novel criteria correlated with appropriate treatment decisions, prognosis prediction, and treatment responses.