High frequency of unusual gastric/duodenal ulcers in patients with Behcet's disease in Taiwan: a possible correlation of MHC molecules with the development of gastric/duodenal ulcers

The gastrointestinal (GI) involvement of Behcet's disease (BD) mainly affects the ileocecal region and colon. The gastroduodenal mucosa appears to be the least frequently involved segment of the gastrointestinal tract. The objective of this study was to assess the severity of gastric/duodenal involvement in BD patients in Taiwan. Behcet's disease was diagnosed according to the diagnostic criteria issued by the International Study Group for Behcet's Disease. We obtained and recorded clinical and laboratory data. A routine endoscopic examination with a urease test for Helicobacter pylori infection was arranged. Furthermore, HLA tissue typing was also performed by polymerase chain reaction with sequence-specific primers to evaluate the possible genetic loads associated with ulcer development. A total 28 BD patients, diagnosed at DaLin TzuChi hospital from 1999 to 2002, were enrolled in this study. The prevalence rate of gastric/duodenal ulceration was 43% (six patients had combined gastric and duodenal ulcers, three patients had simple gastric ulcers, and three patients had simple duodenal ulcers). No risk factors of nonsteroidal anti-inflammatory drug (NSAID) or H. pylori infection were found to be associated with gastrointestinal ulcers in our BD patients. All patients with peptic ulcers responded well to systemic steroids and immunosuppressant treatment in this preliminary observation. Furthermore, 7 of 12 gastric/duodenal ulcer patients (58%) carried an A2/B46/ Cw1 or A11/B46/Cw1 genotype. Our data indicated that gastric/duodenal ulcers were a common manifestation in Chinese patients with BD in Taiwan in close association with the distinct genotypes of A2/B46/Cw1 or A11/B46/ Cw1. A good response to systemic steroids, rather than conventional H2 blockers, might be due to downregulation of the vasculitis.