Differentiating gastrointestinal tuberculosis and Crohn's disease- a comprehensive review
Abstract Gastrointestinal Tuberculosis (GITB) and Crohn’s disease (CD) are both chronic granulomatous diseases with a predilection to involve primarily the terminal ileum. GITB is often considered a disease of the developing world, while CD and inflammatory bowel disease are considered a disease of...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | BMC Gastroenterology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12876-023-02887-0 |
| _version_ | 1797774130109480960 |
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| author | Arup Choudhury Jasdeep Dhillon Aravind Sekar Pankaj Gupta Harjeet Singh Vishal Sharma |
| author_facet | Arup Choudhury Jasdeep Dhillon Aravind Sekar Pankaj Gupta Harjeet Singh Vishal Sharma |
| author_sort | Arup Choudhury |
| collection | DOAJ |
| description | Abstract Gastrointestinal Tuberculosis (GITB) and Crohn’s disease (CD) are both chronic granulomatous diseases with a predilection to involve primarily the terminal ileum. GITB is often considered a disease of the developing world, while CD and inflammatory bowel disease are considered a disease of the developed world. But in recent times, the epidemiology of both diseases has changed. Differentiating GITB from CD is of immense clinical importance as the management of both diseases differs. While GITB needs anti-tubercular therapy (ATT), CD needs immunosuppressive therapy. Misdiagnosis or a delay in diagnosis can lead to catastrophic consequences. Most of the clinical features, endoscopic findings, and imaging features are not pathognomonic for either of these two conditions. The definitive diagnosis of GITB can be clinched only in a fraction of cases with microbiological positivity (acid-fast bacilli, mycobacterial culture, or PCR-based tests). In most cases, the diagnosis is often based on consistent clinical, endoscopic, imaging, and histological findings. Similarly, no single finding can conclusively diagnose CD. Multiparametric-based predictive models incorporating clinical, endoscopy findings, histology, radiology, and serology have been used to differentiate GITB from CD with varied results. However, it is limited by the lack of validation studies for most such models. Many patients, especially in TB endemic regions, are initiated on a trial of ATT to see for an objective response to therapy. Early mucosal response assessed at two months is an objective marker of response to ATT. Prolonged ATT in CD is recognized to have a fibrotic effect. Therefore, early discrimination may be vital in preventing the delay in the diagnosis of CD and avoiding a complicated course. |
| first_indexed | 2024-03-12T22:16:30Z |
| format | Article |
| id | doaj.art-0df230efb1004b6e865364496e649818 |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-03-12T22:16:30Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-0df230efb1004b6e865364496e6498182023-07-23T11:16:04ZengBMCBMC Gastroenterology1471-230X2023-07-0123111910.1186/s12876-023-02887-0Differentiating gastrointestinal tuberculosis and Crohn's disease- a comprehensive reviewArup Choudhury0Jasdeep Dhillon1Aravind Sekar2Pankaj Gupta3Harjeet Singh4Vishal Sharma5Nagaon Medical College HospitalGhent UniversityPostgraduate Institute of Medical Education and ResearchPostgraduate Institute of Medical Education and ResearchPostgraduate Institute of Medical Education and ResearchPostgraduate Institute of Medical Education and ResearchAbstract Gastrointestinal Tuberculosis (GITB) and Crohn’s disease (CD) are both chronic granulomatous diseases with a predilection to involve primarily the terminal ileum. GITB is often considered a disease of the developing world, while CD and inflammatory bowel disease are considered a disease of the developed world. But in recent times, the epidemiology of both diseases has changed. Differentiating GITB from CD is of immense clinical importance as the management of both diseases differs. While GITB needs anti-tubercular therapy (ATT), CD needs immunosuppressive therapy. Misdiagnosis or a delay in diagnosis can lead to catastrophic consequences. Most of the clinical features, endoscopic findings, and imaging features are not pathognomonic for either of these two conditions. The definitive diagnosis of GITB can be clinched only in a fraction of cases with microbiological positivity (acid-fast bacilli, mycobacterial culture, or PCR-based tests). In most cases, the diagnosis is often based on consistent clinical, endoscopic, imaging, and histological findings. Similarly, no single finding can conclusively diagnose CD. Multiparametric-based predictive models incorporating clinical, endoscopy findings, histology, radiology, and serology have been used to differentiate GITB from CD with varied results. However, it is limited by the lack of validation studies for most such models. Many patients, especially in TB endemic regions, are initiated on a trial of ATT to see for an objective response to therapy. Early mucosal response assessed at two months is an objective marker of response to ATT. Prolonged ATT in CD is recognized to have a fibrotic effect. Therefore, early discrimination may be vital in preventing the delay in the diagnosis of CD and avoiding a complicated course.https://doi.org/10.1186/s12876-023-02887-0Abdominal tuberculosisInflammatory bowel diseaseXpert Mtb/RifColonoscopyComputed tomographyHistopathology |
| spellingShingle | Arup Choudhury Jasdeep Dhillon Aravind Sekar Pankaj Gupta Harjeet Singh Vishal Sharma Differentiating gastrointestinal tuberculosis and Crohn's disease- a comprehensive review BMC Gastroenterology Abdominal tuberculosis Inflammatory bowel disease Xpert Mtb/Rif Colonoscopy Computed tomography Histopathology |
| title | Differentiating gastrointestinal tuberculosis and Crohn's disease- a comprehensive review |
| title_full | Differentiating gastrointestinal tuberculosis and Crohn's disease- a comprehensive review |
| title_fullStr | Differentiating gastrointestinal tuberculosis and Crohn's disease- a comprehensive review |
| title_full_unstemmed | Differentiating gastrointestinal tuberculosis and Crohn's disease- a comprehensive review |
| title_short | Differentiating gastrointestinal tuberculosis and Crohn's disease- a comprehensive review |
| title_sort | differentiating gastrointestinal tuberculosis and crohn s disease a comprehensive review |
| topic | Abdominal tuberculosis Inflammatory bowel disease Xpert Mtb/Rif Colonoscopy Computed tomography Histopathology |
| url | https://doi.org/10.1186/s12876-023-02887-0 |
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