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Digestive Diseases and Sciences

, Volume 60, Issue 11, pp 3373–3378 | Cite as

Seasonal Variation in Flares of Intestinal Behçet’s Disease

  • Jin Ha Lee
  • Jae Hee CheonEmail author
  • Sung Pil Hong
  • Tae Il Kim
  • Won Ho Kim
Original Article

Abstract

Background

There have been numerous investigations into the seasonality of several autoimmune diseases and inflammatory bowel disease in an effort to better understand the epidemiology and pathogenesis of these conditions. However, the relationship between the season and disease activity of intestinal Behçet’s disease has not been investigated.

Aims

This study aimed to evaluate the seasonal pattern of exacerbations of intestinal Behçet’s disease.

Methods

We evaluated 268 consecutive patients with intestinal Behçet’s disease who were diagnosed and treated between November 1990 and March 2010 at Severance Hospital, Yonsei University, Seoul, Korea. Patient demographics, onset of symptoms, total number of relapses, and the month of each relapse were recorded. The relationship between the season and flares of intestinal Behçet’s disease was analyzed.

Results

A total of 339 relapses occurred in 142 patients (53 %). The median age at diagnosis was 39 (10–73) years; the median follow-up duration was 74 (7–372) months. The peak seasons for relapse were spring and autumn, especially the months of May and September (p value <0.001). Compared with winter, spring and autumn had higher rates of flares (HR 1.92 and 1.91, respectively, p value <0.001).

Conclusions

In this study, intestinal Behçet’s disease demonstrated a biphasic pattern (peaks in spring and autumn) in exacerbations of disease, suggesting that seasonal or exogenous factors may be involved in the flares of intestinal Behçet’s disease.

Keywords

Intestinal Behçet’s disease Seasonality Disease activity 

Notes

Acknowledgments

This study was supported by a Grant of the Korean Health Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (Grant No. HI13C1345), and the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT, and Future Planning (MSIP) (2013R1A2A2A01067123).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest, financial, or otherwise, with respect to this work.

Ethical statement

This study was approved by the Human Research Review Committee of Severance Hospital, Yonsei University, Korea (4-2010-0822).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

For this type of study, formal consent is not required.

References

  1. 1.
    Kasahara Y, Tanaka S, Nishino M, et al. Intestinal involvement in Behcet’s disease: review of 136 surgical cases in the Japanese literature. Dis Colon Rectum. 1981;24:103–106.CrossRefPubMedGoogle Scholar
  2. 2.
    Suzuki Kurokawa M, Suzuki N. Behcet’s disease. Clin Exp Med. 2004;4:10–20.CrossRefPubMedGoogle Scholar
  3. 3.
    Schlesinger N, Schlesinger M, Seshan SV. Seasonal variation of lupus nephritis: high prevalence of class V lupus nephritis during the winter and spring. J Rheumatol. 2005;32:1053–1057.PubMedGoogle Scholar
  4. 4.
    Hawley DJ, Wolfe F, Lue FA, et al. Seasonal symptom severity in patients with rheumatic diseases: a study of 1424 patients. J Rheumatol. 2001;28:1900–1909.PubMedGoogle Scholar
  5. 5.
    Duarte-Garcia A, Fang H, To CH, et al. Seasonal variation in the activity of systemic lupus erythematosus. J Rheumatol. 2012;39:1392–1398.PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Myszor M, Calam J. Seasonality of ulcerative colitis. Lancet. 1984;2:522–523.CrossRefPubMedGoogle Scholar
  7. 7.
    Zeng L, Anderson FH. Seasonal change in the exacerbations of Crohn’s disease. Scand J Gastroenterol. 1996;31:79–82.CrossRefPubMedGoogle Scholar
  8. 8.
    Moum B, Aadland E, Ekbom A, et al. Seasonal variations in the onset of ulcerative colitis. Gut. 1996;38:376–378.PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Angelucci E, Cocco A, Cesarini M, et al. Monthly and seasonal birth patterns and the occurrence of Crohn’s disease. Am J Gastroenterol. 2009;104:1608–1609.CrossRefPubMedGoogle Scholar
  10. 10.
    Aratari A, Papi C, Galletti B, et al. Seasonal variations in onset of symptoms in Crohn’s disease. Dig Liver Dis. 2006;38:319–323.CrossRefPubMedGoogle Scholar
  11. 11.
    Lewis JD, Aberra FN, Lichtenstein GR, et al. Seasonal variation in flares of inflammatory bowel disease. Gastroenterology. 2004;126:665–673.CrossRefPubMedGoogle Scholar
  12. 12.
    Vergara M, Fraga X, Casellas F, et al. Seasonal influence in exacerbations of inflammatory bowel disease. Rev Esp Enferm Dig. 1997;89:357–366.PubMedGoogle Scholar
  13. 13.
    Jung YS, Song CS, Kim ER, et al. Seasonal variation in months of birth and symptom flares in Korean patients with inflammatory bowel disease. Gut Liver. 2013;7:661–667.PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Sakane T, Takeno M, Suzuki N, et al. Behcet’s disease. N Engl J Med. 1999;341:1284–1291.CrossRefPubMedGoogle Scholar
  15. 15.
    Cheon JH, Kim ES, Shin SJ, et al. Development and validation of novel diagnostic criteria for intestinal Behcet’s disease in Korean patients with ileocolonic ulcers. Am J Gastroenterol. 2009;104:2492–2499.CrossRefPubMedGoogle Scholar
  16. 16.
    Cheon JH, Kim WH. An update on the diagnosis, treatment, and prognosis of intestinal Behcet’s disease. Curr Opin Rheumatol. 2015;27:24–31.CrossRefPubMedGoogle Scholar
  17. 17.
    Krause I, Shraga I, Molad Y, et al. Seasons of the year and activity of SLE and Behcet’s disease. Scand J Rheumatol. 1997;26:435–439.CrossRefPubMedGoogle Scholar
  18. 18.
    Ebert EC. Gastrointestinal manifestations of Behcet’s disease. Dig Dis Sci. 2009;54:201–207.CrossRefPubMedGoogle Scholar
  19. 19.
    Tysk C, Jarnerot G. Seasonal variation in exacerbations of ulcerative colitis. Scand J Gastroenterol. 1993;28:95–96.CrossRefPubMedGoogle Scholar
  20. 20.
    Karamanolis DG, Delis KC, Papatheodoridis GV, et al. Seasonal variation in exacerbations of ulcerative colitis. Hepatogastroenterology. 1997;44:1334–1338.PubMedGoogle Scholar
  21. 21.
    Riley SA, Mani V, Goodman MJ, et al. Why do patients with ulcerative colitis relapse? Gut. 1990;31:179–183.PubMedCentralCrossRefPubMedGoogle Scholar
  22. 22.
    Sonnenberg A, Jacobsen SJ, Wasserman IH. Periodicity of hospital admissions for inflammatory bowel disease. Am J Gastroenterol. 1994;89:847–851.PubMedGoogle Scholar
  23. 23.
    Bai A, Guo Y, Shen Y, et al. Seasonality in flares and months of births of patients with ulcerative colitis in a Chinese population. Dig Dis Sci. 2009;54:1094–1098.CrossRefPubMedGoogle Scholar
  24. 24.
    Don BA, Goldacre MJ. Absence of seasonality in emergency hospital admissions for inflammatory bowel disease. Lancet. 1984;2:1156–1157.CrossRefPubMedGoogle Scholar
  25. 25.
    Soncini M, Triossi O, Leo P, et al. Seasonal patterns of hospital treatment for inflammatory bowel disease in Italy. Digestion. 2006;73:1–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Lee GJ, Dotson JL, Kappelman MD, et al. Seasonality and pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2014;59:25–28.CrossRefPubMedGoogle Scholar
  27. 27.
    Gebhard RL, Greenberg HB, Singh N, et al. Acute viral enteritis and exacerbations of inflammatory bowel disease. Gastroenterology. 1982;83:1207–1209.PubMedGoogle Scholar
  28. 28.
    Newman A, Lambert JR. Campylobacter jejuni causing flare-up in inflammatory bowel disease. Lancet. 1980;2:919.CrossRefPubMedGoogle Scholar
  29. 29.
    Sonnenberg A. Seasonal variation of enteric infections and inflammatory bowel disease. Inflamm Bowel Dis. 2008;14:955–959.CrossRefPubMedGoogle Scholar
  30. 30.
    Moore M, Centers for Disease Control. Enteroviral disease in the United States, 1970–1979. J Infect Dis. 1982;146:103–108.CrossRefPubMedGoogle Scholar
  31. 31.
    Mee AS, Jewell DP. Factors inducing relapse in inflammatory bowel disease. Br Med J. 1978;2:801–802.PubMedCentralCrossRefPubMedGoogle Scholar
  32. 32.
    Kangro HO, Chong SK, Hardiman A, et al. A prospective study of viral and mycoplasma infections in chronic inflammatory bowel disease. Gastroenterology. 1990;98:549–553.PubMedGoogle Scholar
  33. 33.
    Kim MR, Lee HR, Lee GM. Epidemiology of acute viral respiratory tract infections in Korean children. J Infect. 2000;41:152–158.CrossRefPubMedGoogle Scholar
  34. 34.
    Ahn KM, Chung SH, Chung EH, et al. Clinical characteristics of acute viral lower respiratory tract infections in hospitalized children in Seoul, 1996–1998. J Korean Med Sci. 1999;14:405–411.PubMedCentralCrossRefPubMedGoogle Scholar
  35. 35.
    Cantorna MT, Zhu Y, Froicu M, et al. Vitamin D status, 1,25-dihydroxyvitamin D3, and the immune system. Am J Clin Nutr. 2004;80:1717s–1720s.PubMedGoogle Scholar
  36. 36.
    Hayes CE, Nashold FE, Spach KM, et al. The immunological functions of the vitamin D endocrine system. Cell Mol Biol (Noisy-le-grand). 2003;49:277–300.Google Scholar
  37. 37.
    Kamen DL, Tangpricha V. Vitamin D and molecular actions on the immune system: modulation of innate and autoimmunity. J Mol Med (Berl). 2010;88:441–450.CrossRefGoogle Scholar
  38. 38.
    Rigby WF, Waugh M, Graziano RF. Regulation of human monocyte HLA-DR and CD4 antigen expression, and antigen presentation by 1,25-dihydroxyvitamin D3. Blood. 1990;76:189–197.PubMedGoogle Scholar
  39. 39.
    Penna G, Adorini L. 1-α,25-Dihydroxyvitamin D3 inhibits differentiation, maturation, activation, and survival of dendritic cells leading to impaired alloreactive T cell activation. J Immunol. 2000;164:2405–2411.CrossRefPubMedGoogle Scholar
  40. 40.
    Canning MO, Grotenhuis K, de Wit H, et al. 1-α,25-Dihydroxyvitamin D3 (1,25(OH)(2)D(3)) hampers the maturation of fully active immature dendritic cells from monocytes. Eur J Endocrinol. 2001;145:351–357.CrossRefPubMedGoogle Scholar
  41. 41.
    Griffin MD, Lutz WH, Phan VA, et al. Potent inhibition of dendritic cell differentiation and maturation by vitamin D analogs. Biochem Biophys Res Commun. 2000;270:701–708.CrossRefPubMedGoogle Scholar
  42. 42.
    Yap KS, Morand EF. Vitamin D and systemic lupus erythematosus: continued evolution. Int J Rheum Dis. 2015;18:242–249.CrossRefPubMedGoogle Scholar
  43. 43.
    Mouli VP, Ananthakrishnan AN. Review article: vitamin D and inflammatory bowel diseases. Aliment Pharmacol Ther. 2014;39:125–136.CrossRefPubMedGoogle Scholar
  44. 44.
    Rossini M, Maddali Bongi S, La Montagna G, et al. Vitamin D deficiency in rheumatoid arthritis: prevalence, determinants and associations with disease activity and disability. Arthritis Res Ther. 2010;12:R216.PubMedCentralCrossRefPubMedGoogle Scholar
  45. 45.
    Gatenby P, Lucas R, Swaminathan A. Vitamin D deficiency and risk for rheumatic diseases: an update. Curr Opin Rheumatol. 2013;25:184–191.CrossRefPubMedGoogle Scholar
  46. 46.
    Jorgensen SP, Hvas CL, Agnholt J, et al. Active Crohn’s disease is associated with low vitamin D levels. J Crohns Colitis. 2013;7:e407–e413.CrossRefPubMedGoogle Scholar
  47. 47.
    Khabbazi A, Rashtchizadeh N, Ghorbanihaghjo A, et al. The status of serum vitamin D in patients with active Behcet’s disease compared with controls. Int J Rheum Dis. 2014;17:430–434.CrossRefPubMedGoogle Scholar
  48. 48.
    Can M, Gunes M, Haliloglu OA, et al. Effect of vitamin D deficiency and replacement on endothelial functions in Behcet’s disease. Clin Exp Rheumatol. 2012;30:S57–S61.PubMedGoogle Scholar
  49. 49.
    Kini GP, Young B, Herbison P, et al. Does seasonal level of serum 25-OH vitamin D correlate with the activity of Crohn’s disease? N Z Med J. 2014;127:51–59.PubMedGoogle Scholar
  50. 50.
    Turhanoglu AD, Guler H, Yonden Z, et al. The relationship between vitamin D and disease activity and functional health status in rheumatoid arthritis. Rheumatol Int. 2011;31:911–914.CrossRefPubMedGoogle Scholar
  51. 51.
    Melin A, Wilske J, Ringertz H, et al. Seasonal variations in serum levels of 25-hydroxyvitamin D and parathyroid hormone but no detectable change in femoral neck bone density in an older population with regular outdoor exposure. J Am Geriatr Soc. 2001;49:1190–1196.CrossRefPubMedGoogle Scholar
  52. 52.
    Klenk J, Rapp K, Denkinger MD, et al. Seasonality of vitamin D status in older people in Southern Germany: implications for assessment. Age Ageing. 2013;42:404–408.CrossRefPubMedGoogle Scholar
  53. 53.
    Chung IH, Kim HJ, Chung S, et al. Vitamin D deficiency in Korean children: prevalence, risk factors, and the relationship with parathyroid hormone levels. Ann Pediatr Endocrinol Metab. 2014;19:86–90.PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Jin Ha Lee
    • 1
  • Jae Hee Cheon
    • 1
    Email author
  • Sung Pil Hong
    • 1
  • Tae Il Kim
    • 1
  • Won Ho Kim
    • 1
  1. 1.Department of Internal Medicine and Institute of GastroenterologyYonsei University College of MedicineSeoulKorea

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