A recent multicenter study published in Digestive Endoscopy has introduced and validated a novel severity classification system for intestinal Behçet’s disease, offering a more clinically relevant framework for treatment decision-making and prognostic assessment. The study demonstrated that this new tool closely correlates with disease activity, therapeutic choices, and patient outcomes, addressing a long-standing gap in the management of this complex condition.
Intestinal involvement in Behçet’s disease is associated with a high risk of relapse, complications, and poor prognosis, particularly in patients with severe disease requiring surgical intervention. Accurate assessment of disease severity is therefore critical in routine clinical practice, as intestinal Behçet’s disease can progress to life-threatening complications such as intestinal perforation. Importantly, disease severity may not always correlate with symptoms, underscoring the need for objective assessment tools that incorporate endoscopic findings even in asymptomatic patients.
Although general severity criteria for Behçet’s disease exist in Japan, no clear, standardized definition specific to intestinal Behçet’s disease has been established. Previous treatment guidelines have broadly categorized therapy based on disease severity, recommending 5-aminosalicylates for mild-to-moderate disease and corticosteroids or anti-tumor necrosis factor-alpha (anti-TNF-α) agents for moderate-to-severe disease. However, the lack of a well-defined, intestinal-specific severity classification has limited clinicians’ ability to tailor treatment appropriately.
To address this unmet need, investigators conducted a multicenter observational study involving 146 patients with intestinal Behçet’s disease or simple ulcers, recruited from 14 institutions between April and November 2022. The newly proposed Severity Classification for Intestinal Behçet’s Disease (SCIBD) integrates five clinically relevant parameters: abdominal pain, abdominal tenderness, intestinal bleeding, serum C-reactive protein (CRP) levels, and endoscopic findings. Based on these criteria, disease severity was categorized into four stages: remission, mild, moderate, and severe.
Analysis revealed a strong correlation between increasing SCIBD severity and markers of inflammation and disease activity. Higher SCIBD grades were associated with significantly elevated CRP levels and Disease Activity Index for Intestinal Behçet’s Disease (DAIBD) scores, alongside a proportional reduction in serum albumin levels. These associations remained robust when the analysis was restricted to patients with intestinal Behçet’s disease alone.
Importantly, treatment patterns aligned closely with SCIBD severity. Anti-TNF-α therapy was used significantly more often in patients with severe disease (49.4%) compared with those with moderate disease (20.8%; p = 0.001). In contrast, corticosteroid use did not differ significantly between moderate and severe groups (39.6% vs. 33.3%). Notably, the conventional DAIBD classification failed to demonstrate meaningful differences in corticosteroid use, anti-TNF-α therapy, or surgical intervention rates across its severity categories, highlighting the limitations of existing assessment tools.
The SCIBD also demonstrated responsiveness to treatment. Disease severity scores improved following corticosteroid and anti-TNF-α therapy, reflecting parallel improvements in clinical symptoms, inflammatory markers, and endoscopic findings. This dynamic responsiveness supports the utility of SCIBD not only as a baseline assessment tool but also as a means of monitoring therapeutic response over time.
The authors conclude that the SCIBD provides a practical and clinically meaningful framework for assessing intestinal Behçet’s disease severity, facilitating more appropriate treatment selection and more accurate prognosis prediction. They suggest that future incorporation of emerging biomarkers may further refine the classification system, paving the way for more personalized and outcome-driven management strategies in intestinal Behçet’s disease.
Reference
Fukui T, Naganuma M, Kirino Y, Kunisaki R, Mikami Y, Ueno N, Umeno J, Bamba S, Ooi M, Hosomi S, Matsumoto T, Matsuoka K, Watanabe C, Nagahori M, Uchino M, Watanabe K, Hirai F, Matsuura M, Tanaka Y, Takeno M, Hisamatsu T. A Multicenter Observational Study for the Establishment of Novel Severity Criteria Including Endoscopic Evaluation for Intestinal Behçet’s Disease. Dig Endosc. 2026 Jan;38(1):e70041.