**12. Apremilast**

This treatment led to rapid improvement of oral and genital ulcers and reduction of glucocorticoid dose with no difference between monotherapy and combination

therapy. Other BS manifestations such as intestinal symptoms also improved [29], but apremilast can frequently present with severe gastrointestinal adverse effects [30], which can be limiting of its use in EB in the future.

## **13. Surgery**

Surgical management in EB is required in cases complicated with perforation and massive bleeding and can be salutary in some cases of abdominal abscess, fistula, and stricture. Additionally, patients who are refractory to medical treatment will benefit from surgical treatment [31]. Surgery in EB will be less and less used with the rising usage of biologics.

#### **14. Prognosis and follow-up**

Clinical remission has been a long-standing goal of therapy in patients with EB, but recently, with analogy to CD, researchers are paying increasing attention to endoscopic remission, which is also termed as mucosal healing [16], which would be in the future a major therapeutic target, especially with the advent of biologics. Mucosal healing is defined as the complete absence of inflammatory and ulcerative lesions in all segments of the gut on endoscopic examination [16].

The occurrence of intestinal involvement is generally considered an indicator of poor prognosis with increased morbidity and mortality, due the important prevalence of digestive bleeding, intestinal perforation, fistulas, which will often require surgery. Risk factors for developing intestinal manifestations were found to be male gender, elevated ESR, CRP, IL-6 and decreased hemoglobin [6]. The relapses were also studied and were more likely to occur in patients with intestinal ulcers in the ileoceocal and colorectal regions or in patients with poor compliance [32]. To date, there are no established guidelines for surveillance.

#### **15. Conclusion**

Entero-Behcet can be a challenging aspect of Behcet's disease to diagnose and to treat. It can also bear a poor prognosis. Many efforts were made to help the diagnosis, especially to distinguish it from Crohn disease, by developing classification scores and severity disease index. Treatment strategies have also benefited from the rise of biologics use with advantageous results, which has permitted to target not only clinical remission but also mucosal healing. But there is a need to provide more robust evidence-based therapeutic protocols and to establish guidelines for endoscopic surveillance.
