Indications for surgery in intestinal Behçet's disease

Background/Aims: As advances in steroids and immunosuppressants made medical treatment first-line therapy for Behcet's disease, the criteria for elective surgery became unclear. The aim of this paper is to establish surgical criteria for Behcet's. Methodology: We reviewed the medical records of 8 consecutive Japanese patients who were diagnosed with intestinal Behcet's at Tsukuba University Hospital between 1976 and 2001. Records were examined for medical treatment including dose of steroids, and surgical treatment including length of resected intestine, incidence of recurrence, and the form and site of recurrence. Results: Elective surgery was performed in cases where the preoperative steroid administration could not be reduced to under 40mg/day, once steroids exceeded 40mg/day to control symptoms and inflammation. Cases with emergency operations (perforated cases), the preoperative doses of steroids were not so high (0, 0, 10, 20mg/day). In all cases, the post-surgical steroid dose was reduced under 20mg/day. Three cases showed recurrence after surgery within 2 years. These cases also had an increase in steroid dosage at the time of recurrence, but have been controlled medically so far. Conclusions: Surgery should be strongly considered when the steroid dose exceeds 40mg/day.