Differentiation of Crohnʼs Disease from Intestinal Tuberculosis by Clinical and CT Enterographic Models

Zhao, Xuesong; Wang, Zhengting; Wu, Zhiyong; Yin, Qiang; Zhong, Jie; Miao, Fei; Yan, Fu-Hua

doi:10.1097/mib.0000000000000025

Cited by 64 publications

(76 citation statements)

References 29 publications

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“…The median duration in CD (6–53.3 months, range 0.3–300 months) was significantly greater than that in ITB (3–23.4 months, range 0–120 months) in five of the studies (1,6,12–14,16,30). In the other studies, the reported mean duration of symptoms in meta-analysis was 26.5 months (95% CI=15.7–37.3) longer for CD compared with that for ITB (2,11,15,31–34). Although the studies reporting means had a very high heterogeneity with I 2 of 97.7%, all of the studies showed a longer duration in CD (Supplementary Figures online).…”

Section: Resultsmentioning

confidence: 88%

“…ESR was reported in continuous values in six studies (four for mean and two for median) (1,11,12,15,17,34) and in dichotomous results (normal vs. abnormal value) in four studies (2,33,35,36). Meta-analyses were performed separately.…”

Section: Resultsmentioning

confidence: 99%

“…CRP was reported in continuous value in seven studies (five for mean and two for median) (2,12,13,35–38) and in dichotomous results in three studies (11,15,34). The proportion of patients with high CRP was significantly higher in CD in the studies reporting dichotomous results; however, CRP level tended to be higher but not statistically significant in ITB among the studies reporting CRP in mean (Supplementary Figures online).…”

Section: Resultsmentioning

confidence: 99%

“…Albumin level was reported in six studies (1,11,12,15,34,35). There was no significant difference in the albumin level between CD and ITB, and it was not included in the model.…”

Section: Resultsmentioning

confidence: 99%

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Meta-Analytic Bayesian Model For Differentiating Intestinal Tuberculosis from Crohn's Disease

Limsrivilai

Shreiner

Pongpaibul

et al. 2017

American Journal of Gastroenterology

101

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Objectives Distinguishing intestinal tuberculosis (ITB) from Crohn's disease (CD) is difficult, although studies have reported clinical, endoscopic, imaging, and laboratory findings that help to differentiate these two diseases. We aimed to produce estimates of the predictive power of these findings and construct a comprehensive model to predict the probability of ITB vs. CD. Methods A systematic literature search for studies differentiating ITB from CD was conducted in MEDLINE, PUBMED, and EMBASE from inception until September 2015. Fifty-five distinct meta-analyses were performed to estimate the odds ratio of each predictive finding. Estimates with a significant difference between CD and ITB and low to moderate heterogeneity (I2 <50%) were incorporated into a Bayesian prediction model incorporating the local pretest probability. Results Thirty-eight studies comprising 2,117 CD and 1,589 ITB patients were included in the analyses. Findings in the model that significantly favored CD included male gender, hematochezia, perianal disease, intestinal obstruction, and extraintestinal manifestations; endoscopic findings of longitudinal ulcers, cobblestone appearance, luminal stricture, mucosal bridge, and rectal involvement; pathological findings of focally enhanced colitis; and computed tomographic enterography (CTE) findings of asymmetrical wall thickening, intestinal wall stratification, comb sign, and fibrofatty proliferation. Findings that significantly favored ITB included fever, night sweats, lung involvement, and ascites; endoscopic findings of transverse ulcers, patulous ileocecal valve, and cecal involvement; pathological findings of confluent or submucosal granulomas, lymphocyte cuffing, and ulcers lined by histiocytes; a CTE finding of short segmental involvement; and a positive interferon-γ release assay. The model was validated by gender, clinical manifestations, endoscopic, and pathological findings in 49 patients (27 CD, 22 ITB). The sensitivity, specificity, and accuracy for diagnosis of ITB were 90.9%, 92.6%, and 91.8%, respectively. Conclusions A Bayesian model based on the meta-analytic results is presented to estimate the probability of ITB and CD calibrated to local prevalence. This model can be applied to patients using a publicly available web application.

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Section: Resultsmentioning

confidence: 88%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Albumin level was reported in six studies (1,11,12,15,34,35). There was no significant difference in the albumin level between CD and ITB, and it was not included in the model.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Meta-Analytic Bayesian Model For Differentiating Intestinal Tuberculosis from Crohn's Disease

Limsrivilai

Shreiner

Pongpaibul

et al. 2017

American Journal of Gastroenterology

101

View full text Add to dashboard Cite

show abstract

“…This model had high specificity and positive predictive value; however, the sensitivity was relatively low because of the low frequency of individual features in either disease. Numerous recent studies have also evaluated the role of CT in differentiating between CD and ITB 2021222324. Therefore, we tried to collate the results of all these studies to evaluate the overall role of CT in differentiating between CD and ITB.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of computed tomographic features in differentiating intestinal tuberculosis from Crohn's disease: a systematic review with meta-analysis

et al. 2017

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Abdominal computed tomography (CT) can noninvasively image the entire gastrointestinal tract and assess extraintestinal features that are important in differentiating Crohn's disease (CD) and intestinal tuberculosis (ITB). The present meta-analysis pooled the results of all studies on the role of CT abdomen in differentiating between CD and ITB. We searched PubMed and Embase for all publications in English that analyzed the features differentiating between CD and ITB on abdominal CT. The features included comb sign, necrotic lymph nodes, asymmetric bowel wall thickening, skip lesions, fibrofatty proliferation, mural stratification, ileocaecal area, long segment, and left colonic involvements. Sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio (DOR) were calculated for all the features. Symmetric receiver operating characteristic curve was plotted for features present in >3 studies. Heterogeneity and publication bias was assessed and sensitivity analysis was performed by excluding studies that compared features on conventional abdominal CT instead of CT enterography (CTE). We included 6 studies (4 CTE, 1 conventional abdominal CT, and 1 CTE+conventional abdominal CT) involving 417 and 195 patients with CD and ITB, respectively. Necrotic lymph nodes had the highest diagnostic accuracy (sensitivity, 23%; specificity, 100%; DOR, 30.2) for ITB diagnosis, and comb sign (sensitivity, 82%; specificity, 81%; DOR, 21.5) followed by skip lesions (sensitivity, 86%; specificity, 74%; DOR, 16.5) had the highest diagnostic accuracy for CD diagnosis. On sensitivity analysis, the diagnostic accuracy of other features excluding asymmetric bowel wall thickening remained similar. Necrotic lymph nodes and comb sign on abdominal CT had the best diagnostic accuracy in differentiating CD and ITB.

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Ileocecal thickening: Clinical approach to a common problem

et al. 2019

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Ileocecal thickening (ICT) is a common finding on radiological imaging. It can be caused by a variety of inflammatory, infectious, or neoplastic conditions, and evaluating a patient of ICT can be a challenging task. Intestinal tuberculosis (ITB), Crohn's disease (CD), and adenocarcinoma are the most common causes. Enteric bacterial infections, cytomegalovirus, histoplasmosis, amebiasis, systemic vasculitis, lymphoma, etc. should be suspected in appropriate clinical settings. However, it could often be a spurious or nonspecific finding. A thickness of more than 3 mm in a normally distended small bowel is usually considered abnormal. Detailed evaluation of imaging of the site and extent of thickening; the degree and pattern of thickening; and the associated findings, such as degree of fat stranding, fibrofatty proliferation, adjacent lymph nodes, and solid organ involvement, should be performed. Ileocolonoscopy is an important tool for diagnosing and obtaining samples for tissue diagnosis. Histopathology is usually the gold standard for diagnosis, although-not uncommonly-findings could be nonspecific, and reaching a definitive diagnosis is difficult. As such, a systematic approach with the integration of clinical, biochemical, radiological, endoscopic, histological, and other laboratory tests is the key to reaching a diagnosis. In this article, we review the causes of ICT and present a clinical approach for the management of ICT. Causes of ICTThe ileocecal area could be involved by a variety of conditions, including benign or malignant tumors, infections, inflammatory conditions, ischemia, etc. However, ICT can also be a spurious finding, without any underlying cause. In various studies on bowel wall thickening, a normal ileocolonoscopy has been found

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Differentiation of Crohnʼs Disease from Intestinal Tuberculosis by Clinical and CT Enterographic Models

Abstract: The accuracy of CT enterographic model suggests the possibility of using CT enterography as an alternative to endoscopy in the differentiation between CD and ITB.

Cited by 64 publications

References 29 publications

Meta-Analytic Bayesian Model For Differentiating Intestinal Tuberculosis from Crohn's Disease

Meta-Analytic Bayesian Model For Differentiating Intestinal Tuberculosis from Crohn's Disease

Accuracy of computed tomographic features in differentiating intestinal tuberculosis from Crohn's disease: a systematic review with meta-analysis

Ileocecal thickening: Clinical approach to a common problem

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