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Budd–Chiari syndrome in Behçet’s disease: a retrospective multicenter study

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Abstract

Objective

To compare the clinical features, laboratory findings, and prognosis of Behçet’s disease (BD) patients with and without Budd–Chiari syndrome (BCS).

Methods

This multicenter retrospective study investigated 61 (M/F: 41/20) patients with BD, having coexistent BCS, and 169 (M/F:100/69) BD patients as the control group without BCS from 22 different centers of Turkey diagnosed between 1990 and 2017.

Results

Of the total 61 BD patients with BCS, the onset of the first symptom and the median age of diagnosis were earlier in contrast to BD patients without BCS (p = 0.005 and p = 0.007). Lower extremity deep vein and inferior vena cava (IVC) thrombosis were more common in patients with BCS (all; p < 0.01) compared to the control group. Mortality was significantly higher in BD-BCS patients with IVC thrombosis than in the controls (p = 0.004). Since most of the cases in our cohort had chronic and silent form of BCS, mortality rate was 14.8%, which was on the lower range of mortality rate reported in literature (14–47%). While all BD-BCS patients received immunosuppressive (IS) agents, only half of them received additional anticoagulant treatments. Among IS agents, interferon treatment was more frequently used in this cohort (19%), compared to other series reported in literature (2.3%).

Conclusion

To our knowledge, this is the largest series of BD patients with BCS. Our patients had earlier disease onset and diagnosis, higher frequency of IVC thrombosis, and higher mortality rate, compared to BD patients without BCS. Mortality was significantly higher in BD-BCS patients with IVC thrombosis compared to controls.

Key Points

Mortality rate is higher in BD-associated BCS patients with IVC involvement.

Chronic and silent form of BD-associated BCS has a better prognosis.

The main treatment options are corticosteroids and immunosuppressive agents, whereas anticoagulant treatment remains controversial.

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Availability of data and materials

Data is available upon a reasonable request.

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References

  1. Janssen HL, Garcia-Pagan JC, Elias E, Mentha G, Hadengue A, Valla DC (2003) Budd-Chiari syndrome: a review by an expert panel. J Hepatol 38(3):364–371

    Article  Google Scholar 

  2. Pavri TM, Herbst A, Reddy R, Forde KA (2014) Budd-Chiari syndrome: a single-center experience. World J Gastroenterol 20(43):16236–16244

    Article  Google Scholar 

  3. Uskudar O, Akdogan M, Sasmaz N, Yilmaz S, Tola M, Sahin B (2008) Etiology and portal vein thrombosis in Budd-Chiari syndrome. World J Gastroenterol 14(18):2858–2862

    Article  Google Scholar 

  4. Darwish Murad S, Plessier A, Hernandez-Guerra M, Fabris F, Eapen CE, Bahr MJ et al (2009) Etiology, management, and outcome of the Budd-Chiari syndrome. Ann Intern Med 151(3):167–175

    Article  Google Scholar 

  5. Harmanci O, Kav T, Peynircioglu B, Buyukasik Y, Sokmensuer C, Bayraktar Y (2013) Long-term follow-up study in Budd-Chiari syndrome: single-center experience in 22 years. J Clin Gastroenterol 47(8):706–712

    Article  Google Scholar 

  6. Seyahi E, Caglar E, Ugurlu S, Kantarci F, Hamuryudan V, Sonsuz A et al (2015) An outcome survey of 43 patients with Budd-Chiari syndrome due to Behçet’s syndrome followed up at a single, dedicated center. Semin Arthritis Rheum 44(5):602–609

    Article  Google Scholar 

  7. Bayraktar Y, Balkanci F, Bayraktar M, Calguneri M (1997) Budd-Chiari syndrome: a common complication of Behçet’s disease. Am J Gastroenterol 92(5):858–862

    PubMed  CAS  Google Scholar 

  8. Cansu DU, Temel T, Erturk A, Kasifoglu T, Acu B, Korkmaz C (2016) The long-term outcomes for patients with Budd-Chiari syndrome caused by Behcet’s disease: a case series on the results, from cirrhosis to death. Hepatitis monthly. 16(10):e32457

    Article  Google Scholar 

  9. Criteria for diagnosis of Behçet’s disease (1990) International Study Group for Behçet’s Disease. Lancet (London, England) 335(8697):1078–1080

    Google Scholar 

  10. Rothman KJ (2002) Epidemiology: an introduction. Oxford University Press, New York, NY, p 134

    Google Scholar 

  11. Turkish Statistical Institute (2020). Population Censuses. https://data.tuik.gov.tr/Kategori/GetKategori?p=Population-and-Demography-109. Accessed 13 May 2020

  12. Turkish Ministry of Health (2019). National Death Reporting System. https://obs.saglik.gov.tr. Accessed 28 May 2019

  13. Seyahi E (2016) Behçet’s disease: How to diagnose and treat vascular involvement. Best Pract Res Clin Rheumatol 30(2):279–295

    Article  Google Scholar 

  14. Tascilar K, Melikoglu M, Ugurlu S, Sut N, Caglar E, Yazici H (2014) Vascular involvement in Behçet’s syndrome: a retrospective analysis of associations and the time course. Rheumatology (Oxford) 53(11):2018–2022

    Article  CAS  Google Scholar 

  15. Desbois AC, Rautou PE, Biard L, Belmatoug N, Wechsler B, Resche-Rigon M et al (2014) Behcet’s disease in Budd-Chiari syndrome. Orphanet J Rare Dis 9:104

    Article  Google Scholar 

  16. Sakr MA, Reda MA, Ebada HE, Abdelmoaty AS, Hefny ZM, Ibrahim ZH et al (2020) Characteristics and outcome of primary Budd-Chiari syndrome due to Behçet’s syndrome. Clin Res Hepatol Gastroenterol 44(4):503–512

    Article  Google Scholar 

  17. Ben Ghorbel I, Ennaifer R, Lamloum M, Khanfir M, Miled M, Houman MH (2008) Budd-Chiari syndrome associated with Behçet’s disease. Gastroenterol Clin Biol 32(3):316–320

    Article  CAS  Google Scholar 

  18. Hatemi G, Christensen R, Bang D, Bodaghi B, Celik AF, Fortune F et al (2018) 2018 update of the EULAR recommendations for the management of Behçet’s syndrome. Ann Rheum Dis 77(6):808–818

    PubMed  Google Scholar 

  19. Seyahi E, Yazici H (2016) To anticoagulate or not to anticoagulate vascular thrombosis in Behçet’s syndrome: an enduring question. Clin Exp Rheumatol 34(1 Suppl 95):S3-4

    PubMed  Google Scholar 

  20. Tayer-Shifman OE, Seyahi E, Nowatzky J, Ben-Chetrit E (2012) Major vessel thrombosis in Behçet’s disease: the dilemma of anticoagulant therapy - the approach of rheumatologists from different countries. Clin Exp Rheumatol 30(5):735–740

    PubMed  Google Scholar 

  21. Mehta P, Laffan M, Haskard DO (2010) Thrombosis and Behçet’s syndrome in non-endemic regions. Rheumatology (Oxford) 49(11):2003–2004

    Article  Google Scholar 

  22. Hatemi G, Silman A, Bang D, Bodaghi B, Chamberlain AM, Gul A et al (2008) EULAR recommendations for the management of Behçet disease. Ann Rheum Dis 67(12):1656–1662

    Article  CAS  Google Scholar 

  23. Korkmaz C, Kasifoglu T, Kebapçi M (2007) Budd-Chiari syndrome in the course of Behcet’s disease: clinical and laboratory analysis of four cases. Joint Bone Spine 74(3):245–248

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank the patients.

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L.A and M.S: conceptualization, methodology, software. L.A: writing—original draft. G.K: writing—review and editing. Resources: All authors provided data.

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Correspondence to Lütfi Akyol.

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Akyol, L., Toz, B., Bayındır, Ö. et al. Budd–Chiari syndrome in Behçet’s disease: a retrospective multicenter study. Clin Rheumatol 41, 177–186 (2022). https://doi.org/10.1007/s10067-021-05878-2

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  • DOI: https://doi.org/10.1007/s10067-021-05878-2

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