Background Recurrent oral ulcers (ROU) are an almost constant feature of Behçet's disease (BD) but its pathophysiology is not well understood. It is widely admitted that certain foods or other external factors play a role in BD-related ROU. Thus, the proportion of patients with BD able to identify a specific triggering factor of their ROU and the nature of these factors remain unknown.
Objectives To study the role of dietary and non-dietary factors as triggers of BD-related ROU.
Methods A 23-item self-report questionnaire was given to consecutive in- and outpatients with BD who attended 7 French hospital departments for internal medicine over a 12-month period. Patients were enrolled if they consented to participate in the study and if they had a history of ROU that had not become definitively extinct to ensure patients' ability to provide accurate information. The questionnaire consisted of 13 items collecting general information, e.g., demographic characteristics, dietary habits, age at onset and severity of ROU. Six additional open-ended, dichotomous (“Yes” or “No”) or scaled questions (“Yes, I am sure”, “Yes, that's possible”, “No, that's highly unlikely”, or “I don't know”) collected information on potential triggering factors of ROU. In particular, the questionnaire evaluated the influences of 6 general triggering situations (i.e., fatigue/stress, dental care, tooth brushing, menstruation, infection, and food/drinks), 24 selected food and drink items, 8 physicochemical properties of food (i.e., salty, sweet, bitter, acid, astringent, hard, hot, cold), and the effect of fast eating. The results were described as percentages of positive responses; for scaled questions, the combined responses of “Yes, I am sure” or “Yes, that's possible” were considered positive.
Results Of the 100 questionnaires distributed, 87 were returned and 80 could be used for the analyses. Among those 80 patients (mean age: 41 years, men: 63%), 96% fulfilled the International criteria for BD, 75% had non-French origins and 81% consumed European-style food. The mean time since ROU onset was 19 years and the ROU was judged by 53% as “very discomforting” or “discomforting” over the previous 12 months. Among the 6 general situations suggested, 91% recognized at least 1 of them as “surely” or “possibly” related to their ROU: fatigue/stress (75%) and food/drinks (70%) were the most frequently cited triggering factors. Among the 24 food/drinks items suggested, the most frequently reported items were: walnuts (49%), pineapple (43%), peanuts (33%), Emmental cheese (30%), lemon (25%), almonds (24%), and other cheeses (21%). Acidity was the most frequently reported physicochemical food characteristic triggering ROU (58%).
Conclusions Fatigue/stress and food are frequently recognized triggering factors of BD-related ROU. This implies the need to take into account such external factors in the management of ROU. The fact that most food items identified as common triggers of ROU are histamine-rich or histamine-releasing could suggest a role of histamine in the pathophysiology of BD-related ROU. Hormonal and traumatic components seemed to be of lesser importance in ROU.
Disclosure of Interest None declared