Upper Gastrointestinal Involvement in Behcet's Disease

Background/Aims: Behcet's disease is an idiopathic, chronic, multisystemic vasculitis characterized by recurrent oral and genital ulcers, ophthalmologic inflammation, and skin lesions. This study sought to identify the involvement of the upper gastrointestinal (GI) tract in patients with Behcet's disease. Methods: We retrospectively analyzed 365 patients diagnosed with Behcet's disease at the Jeju National University Hospital from March 2009 to 2021. GI involvement in Behcet's disease was evaluated by endoscopy. Intestinal Behcet's disease was classified according to the presence of typical intestinal ulcers, systemic Behcet's disease, and oral ulcers. Results: A total of 365 patients with Behcet's disease were included; 128 patients underwent endoscopy, including colonoscopy (n=80), upper endoscopy (n=115), and colonoscopy with upper endoscopy (n=68). During colonoscopy (n=80), 17 (21.3%) patients were found to have typical ulcers, 13 (16.3%) atypical ulcers, and 50 (62.5%) had no ileocolic ulcers. During upper endoscopy (n=115), upper GI involvement was found in 14 (12.2%) patients: 21.4% (3/14) in the esophagus, 35.7% (5/14) in the stomach and 42.9% (6/14) in the duodenum. Overall, among those with Behcet's disease, 10.4% (38/365) had GI involvement, with lower GI in 8.2% (30/365) and upper GI in 3.8% (14/365). Conclusions: GI involvement in Behcet's disease in Jeju Island was approximately 10.4%; including lower GI involvement in 8.2% and upper GI in 3.8% of the subjects. The upper GI involvement in Behcet's disease showed typical and atypical ulcers, similar to those of the lower GI tract involvement. (Korean J Gastroenterol 2025;85:170-178)