Behcet's Disease Mimicking Crohn's Disease: A Diagnostic Pitfall in GI Tract Biopsies.

Behcet's disease is a rare entity. It's a multi-systemic inflammatory disease of unknown etiology characterized by recurrent ulcers and vasculitis, mainly including the oral cavity, eyes, gastrointestinal tract and joints. Crohn's disease is a chronic inflammatory disorder that may affect the same organs as Behcet's disease, however more frequently the gastrointestinal tract. Distinguishing Behcet's disease from Crohn's disease can be challenging due to the overlapping clinical presentation and similar morphology features on pathology biopsy specimens. This is a case report of a 32-year-old female who first presented at the emergency department with fatigue, weight loss, arthralgia, and erythema nodosum. The patient was admitted for oral ulcers, skin rash, genital ulcers, and melena one month later. Treatment with prednisone was started at the time and further workup for Behcet's disease versus inflammatory bowel disease was started. Her esophagus biopsy shows granulomatous-like vasculitis, and her colon biopsies show overlapping features with Crohn's disease. Herein, we present a rare and interesting case in which Behcet's disease mimics inflammatory bowel disease on the gastrointestinal tract biopsies but with some unique findings and diagnostic pitfalls for gastrointestinal tract vasculitis and ulceration.

Effects of caregiver burden on quality of life and coping strategies utilized by caregivers of adult patients with inflammatory bowel disease.

BACKGROUND: While previous studies have evaluated caregivers' quality of life (QOL), burnout, and stress amongst across a variety of chronic illnesses, few such studies have been related to inflammatory bowel disease (IBD). METHODS: Caregivers accompanying adult patients with IBD at 6 tertiary centers were enrolled. They completed self-administered surveys related to QOL and burden, including the QOL scale, Zarit Burden Interview (ZBI), and Brief COPE. RESULTS: Of the 200 consecutive caregivers asked to participate, 162 (81.0%) enrolled and completed the survey. A total of 43.8% caregivers reported having a high level of burden as measured by the ZBI. Factors predictive of a high burden included female gender, younger age of caregiver, household income <$30,000, having more than one dependent in the household, caring for a patient with active disease and higher disease severity, and a personal history of psychiatric illness. Over one third of the caregivers reported a maladaptive coping pattern. The caregiver factors predictive of maladaptive coping skills included male gender, lack of involvement in a support group, a personal history of psychiatric illness, and living in a different household from the patient. CONCLUSIONS: A large proportion of caregivers of IBD patients experience a high level of caregiver burden and reduced QOL. Participation in religious/spiritual activities and support groups appeared to reduce perceived caregiver burden and improve QOL. This study suggests there is an unmet need to address the caregiver burden of adult IBD patients.

Coping Strategies Used by Adult Patients with Inflammatory Bowel Disease.

OBJECTIVES: Symptoms of and treatments for inflammatory bowel disease (IBD) have a significant impact on patients' quality of life (QOL) and result in an increased prevalence of depression and anxiety disorders. Little is known about the type of coping strategies used by adult patients with IBD to better cope with their chronic illness, however. The objectives of this study were to identify the types of coping styles and their impact on the QOL of patients with IBD. METHODS: The first 150 consecutive participants with IBD were recruited at five major tertiary hospitals and given an anonymous survey consisting of demographic information, the Jalowiec Coping Scale, and the Shortened Inflammatory Bowel Disease Questionnaire. RESULTS: The cohort was 51.3% men and included 150 participants with a mean age of 39.3 years. The primary coping mechanisms used were confrontive (46.7%), evasiveness (30.0%), optimistic (18.7%), and fatalistic (4.6%) coping. Participants rated confrontive (62.0%), optimistic (26.6%), and evasive (11.4%) coping styles as the most effective. Those who reported an increased frequency of flares scored lower on QOL (P <0.05) and more often used evasive and fatalistic coping styles (P < 0.05) compared with other coping strategies; however, after controlling for disease activity, QOL was significantly better for those who primarily used adaptive coping styles compared with those who used maladaptive styles (P <0.001). CONCLUSIONS: We demonstrated that confrontive, evasive, and optimistic styles of coping are most widely used among patients with IBD. Despite controlling for disease activity, we demonstrated that those who used adaptive coping styles had a higher QOL compared with those who used maladapative coping styles. Future research on coping is warranted to assess coping styles on therapeutic compliance and disease perception.