Differentiating gastrointestinal tuberculosis and Crohn's disease- a comprehensive review

Choudhury, Arup; Dhillon, Jasdeep; Sekar, Aravind; Gupta, Pankaj; Singh, Harjeet; Sharma, Vishal

doi:10.1186/s12876-023-02887-0

Cited by 14 publications

(7 citation statements)

References 111 publications

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“…Several factors contribute to the low frequency of gastric TB, including the bactericidal properties of gastric acid, the presence of thick and intact gastric mucosa, and the absence of lymphoid structures in the gastric mucosa[ 14 , 16 ]. Treatment with H2 blockers increases the likelihood of involvement of the lesser curvature and pylorus in gastric TB, often presenting as ulcerating lesions[ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Primary gastroduodenal tuberculosis presenting as gastric outlet obstruction: A case report and review of literature

Ali,

Mohamed,

Mohamud

et al. 2024

World J Clin Cases

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BACKGROUND Mycobacterium tuberculosis (TB) is the causative agent of TB, a chronic granulomatous illness. This disease is prevalent in low-income countries, posing a significant global health challenge. Gastrointestinal TB is one of the three forms. The disease can mimic other intra-abdominal conditions, leading to delayed diagnosis owing to the absence of specific symptoms. While gastric outlet obstruction (GOO) remains a frequent complication, its incidence has declined with the advent of proton pump inhibitors and Helicobacter pylori eradication therapy. Gastroduodenal TB can cause upper gastrointestinal hemorrhage, obstruction, and malignancy-like tumors. CASE SUMMARY A 23-year-old male presented with recurrent epigastric pain, distension, nausea, vomiting, and weight loss, prompting a referral to a gastroenterologist clinic. Endoscopic examination revealed distorted gastric mucosa and signs of chronic inflammation. However, treatment was interrupted, possibly owing to vomiting or comorbidities such as human immunodeficiency virus infection or diabetes. Subsequent surgical intervention revealed a dilated stomach and diffuse thickening of the duodenal wall. Resection revealed gastric wall effacement with TB. CONCLUSION Primary gastric TB is rare, frequently leading to GOO. Given its rarity, suspicions should be promptly raised when encountering relevant symptoms, often requiring surgical intervention for diagnosis and treatment.

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Section: Discussionmentioning

confidence: 99%

Primary gastroduodenal tuberculosis presenting as gastric outlet obstruction: A case report and review of literature

Ali,

Mohamed,

Mohamud

et al. 2024

World J Clin Cases

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“…Multiparametric-based predictive models incorporating clinical, endoscopy findings, histology, and radiology to differentiate ITB from CD are gaining popularity but have yielded varied results so far. Additionally, there is a lack of validation studies for most of such models [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic utility of CT enterography in the evaluation of ileocecal mucosal lesions of uncertain diagnosis on ileocolonoscopy

Jehangir,

Parry,

Wani

et al. 2023

Pol J Radiol

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PurposeIleocolonoscopy aids in the diagnosis of ileocecal region pathologies when typical mucosal lesions are seen. However, in many cases the mucosal lesions of the ileocaecal region are atypical, rendering themselves to diagnostic dilemma. The present study aimed to study the role of computed tomography (CT) enterography in the evaluation of symptomatic patients who demonstrated ileocecal mucosal lesions of uncertain diagnosis on ileocolonoscopy.Material and methodsSymptomatic patients who had ileocolonoscopy documented ileocecal mucosal lesions of uncertain diagnosis were enrolled. Patients were subjected to CT enterography within 10 days of ileocolonoscopy. On CT enterography a diagnosis of Crohn’s disease (CD) or ileocaecal tuberculosis (ITB) was made. The diagnosis obtained by CT enterography was correlated with the final diagnosis obtained from histopathology. Using descriptive statistics, the diagnostic performance of CT enterography was evaluated.ResultsA total of 153 cases were enrolled in the study. CT enterography findings were present in 147 cases, resulting in a diagnostic yield of 96%. Out of these, 58.16% (89/153) had CD, 26.14% (40/153) had ITB, 6.5% (10/153) had infectious ileitis, and 9.15% (14/153) were indeterminate on histopathology. CT enterography correctly identified 78.65% (70/89) of CD and 75% (30/40) of ITB. CT enterography had a sensitivity of 78.65% and 75%, specificity of 67.19% and 87.61%, positive predictive value of 76.92% and 68.18%, and diagnostic accuracy of 73.86% and 84.31% for diagnosing CD and ITB, respectively.ConclusionsCT enterography provided a high diagnostic yield in ileocaecal mucosal lesions of uncertain significance on endoscopy. CD and ITB were the predominant diseases detected in these individuals. CT enterography had a good diagnostic performance in the detection of these 2 disorders.

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“…Scarring from ulcers can lead to diffuse narrowing, causing gastric outlet obstruction[ 25 ]. Complications resulting from these different forms manifest as hemorrhage, strictures resulting in obstruction, and perforations, including fistula formation[ 26 ].…”

Section: Pathogenesismentioning

confidence: 99%

Recognizing and addressing the challenges of gastrointestinal tuberculosis

Kudu,

Danış

2024

World J Clin Cases

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In this editorial, we comment on the article by Ali et al published in the recent issue of the World Journal of Clinical Cases . This case report shed light on a particularly rare manifestation of this disease-primary gastrointestinal tuberculosis (GTB) presenting as gastric outlet obstruction. GTB presents diagnostic challenges due to its nonspecific symptoms and lack of highly accurate diagnostic algorithms. This editorial synthesizes epidemiological data, risk factors, pathogenesis, clinical presentations, diagnostic methods, and therapies to raise awareness about GTB. GTB constitutes 1%-3% of all tuberculosis cases globally, with 6%-38% of patients also having pulmonary tuberculosis. Pathogenesis involves various modes of Mycobacterium tuberculosis complex entry into the gastrointestinal system, with the terminal ileum and ileocecal valve commonly affected. Clinical presentation varies, often resembling other intra-abdominal pathologies, necessitating a high index of suspicion. Diagnostic tools include a combination of biochemical, microbiological, radiological, and endoscopic assessments. Anti-tubercular medication remains the cornerstone of treatment, supplemented by surgical intervention in severe cases. Multidisciplinary management involving gastroenterologists, surgeons, pulmonologists, and infectious disease specialists is crucial for optimal outcomes. Despite advancements, timely diagnosis and management challenges persist, underscoring the need for continued research and collaboration in addressing primary GTB.

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Differentiating gastrointestinal tuberculosis and Crohn's disease- a comprehensive review

Cited by 14 publications

References 111 publications

Primary gastroduodenal tuberculosis presenting as gastric outlet obstruction: A case report and review of literature

Primary gastroduodenal tuberculosis presenting as gastric outlet obstruction: A case report and review of literature

Diagnostic utility of CT enterography in the evaluation of ileocecal mucosal lesions of uncertain diagnosis on ileocolonoscopy

Recognizing and addressing the challenges of gastrointestinal tuberculosis

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