Effectiveness of interferon-gamma release assays for differentiating intestinal tuberculosis from Crohn’s disease: A meta-analysis

Chen, Wen; Fan, Junhua; Luo, Wei; Peng, Peng; Su, Si-Biao

doi:10.3748/wjg.v19.i44.8133

Cited by 27 publications

(29 citation statements)

References 44 publications

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“…(39) proposed a model with good performance based on the results of a large retrospective cohort in seven centers in Korea, but the model has not been validated outside of Korea. There have been three recent published meta-analyses carried out to determine the utility of pathologic findings and single serological tests such as anti- Saccharomyces cerevisiae antibody and IGRA (40–42). This meta-analysis integrates data from all published studies from inception to September 2015 on 55 distinct predictors and summarizes the findings that have proven useful in differentiating these two conditions.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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

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“…Meta-analyses have been performed on the role of IGRA and histopathology in differentiating CD from ITB 1718. Both meta-analyses on IGRA reported >80% sensitivities and specificities for IGRA in diagnosing ITB with an AUCSROC >0.9.…”

Section: Discussionmentioning

confidence: 99%

“…However, intestinal biopsies are dependent on endoscopic success, and the sensitivity for histological features detailed above is very low, thereby reducing the applicability of these criteria. Among the serologic tests, the anti- Saccharomyces cerevisiae antibody (ASCA) assay could not differentiate between CD and ITB according to a study16 and a recent meta-analysis,17 and interferon gamma release assays (IGRA) had a sensitivity and specificity of only 80% 18…”

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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“…Corticosteroids had been administered in two of three cases with negative IGRAs, including one critically ill patient that resulted in death. Though a meta-analysis of IGRAs in ITB cases revealed a sensitivity of 0.74 and a specificity of 0.87 (23), levels that are slightly lower than those of active pulmonary tuberculosis (24), IGRAs can be used supplemental evaluations when making an IBD diagnosis. Especially, such examinations should be carried out before the administration of corticosteroids or TNF inhibitors.…”

Section: Discussionmentioning

confidence: 99%

Ten Cases of Intestinal Tuberculosis Which Were Initially Misdiagnosed as Inflammatory Bowel Disease

et al. 2019

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Objective Intestinal tuberculosis (ITB) and inflammatory bowel disease (IBD) frequently present with similar clinical, endoscopic and pathological features, therefore it is difficult to differentiate between them. The aim of this study was to elucidate the diagnostic delay and prognosis of ITB cases, initially misdiagnosed as IBD. Methods ITB cases were selected from the hospitalized patient list between April 2004 and March 2017 in a tuberculosis center in Japan. We retrospectively evaluated the initial diagnosis, clinical characteristics, endoscopic and pathological findings, bacterial examinations, treatment and prognosis. Results Among 66 ITB patients, ten patients were initially misdiagnosed as IBD. Seven patients were male and the median age was 60.5 years (23-74 years). After the diagnosis of IBD, all the patients were treated with mesalazine, in addition to corticosteroids in two patients and sequential azathioprine and infliximab in one. The median duration of diagnostic delay was 5.5 months (range 0.5-17 months). Eight patients had active pulmonary tuberculosis at the diagnosis of ITB. Acid-fast bacilli were confirmed in four of seven patients by reevaluation of the pathological specimens at the IBD diagnosis. Two patients needed intestinal resection and one with erroneous corticosteroid use for IBD died due to respiratory failure in spite of receiving appropriate treatment for tuberculosis. Conclusion ITB patients were frequently misdiagnosed and treated as IBD, thus resulting in a poor clinical outcome even after finally making a correct diagnosis and administering appropriate treatment. On diagnosis of IBD and/or treatment failure, chest radiograph and acid-fast bacilli of the pathological specimens should be carefully evaluated in order to rule out tuberculosis.

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Effectiveness of interferon-gamma release assays for differentiating intestinal tuberculosis from Crohn’s disease: A meta-analysis

Abstract: Although IGRAs are not sensitive enough, they provide good specificity for the accurate diagnosis of ITB, which may be helpful in the differential diagnosis of ITB from CD.

Cited by 27 publications

References 44 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

Ten Cases of Intestinal Tuberculosis Which Were Initially Misdiagnosed as Inflammatory Bowel Disease

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