Endoscopic features and treatment response have better prediction rate than clinical symptoms/signs in distinguishing Crohn's disease and intestinal tuberculosis

Lin, Wei‐Chen; Chang, Chen‐Wang; Wang, Tsang‐En; Wang, Horng‐Yuan; Shih, Shou‐Chuan; Chu, Cheng‐Hsin; Hsu, Tzu‐Chi

doi:10.1002/aid2.12121

Cited by 3 publications

(2 citation statements)

References 29 publications

(43 reference statements)

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“…Several endoscopic features have been reported to differentiate Crohn's disease from intestinal tuberculosis, such as longitudinal ulcers, and cobblestone appearance [13,15]. The case with Crohn's disease in our study did not show these two typical endoscopic characteristics and the location of the involved area was con ned to the cecal and terminal ileum.…”

Section: Discussioncontrasting

confidence: 59%

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Endoscopic features and clinical course of patients with asymptomatic cecal ulcers

Lin

Liao

et al. 2022

Preprint

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Background: Cecal ulcers are sometimes encountered in asymptomatic individuals. Their clinical outcomes and management recommendations remain uncertain.Methods: Asymptomatic patients who underwent a colonoscopic exam for colon cancer screening were retrospectively reviewed from July 2009 to November 2016. Patients with cecal ulcers were included. Patients who had colorectal symptoms, such as abdominal pain, had nonsteroidal anti-inflammatory drugs or were lost to follow-up were excluded.Results: A total of 34,036 patients underwent colon cancer screening. Cecal ulcers were found in 35 patients. After exclusion, 24 patients (mean duration, 52 months) received follow-up colonoscopy. In 20 patients, (83.3%), cecal ulcer resolved without intervention, but 4 patients (16.7%) developed clinical significant diseases, including intestinal tuberculosis (n=2), Crohn’s disease (n=1), and ulcerative colitis (n=1). Patients who developed clinically significant diseases had a higher percentage of ulcers larger than 1 cm (75% vs. 15%, p=0.035), terminal ileum involvement (100% vs. 15.4%, p=0.006) and ulcers with irregular fold (75% vs. 5%, p=0.008).Conclusions: In patients with asymptomatic cecal ulcers, the endoscopic features included larger ulcer size, terminal ileum involvement and ulcers with irregular fold may predict development of clinically significant diseases. If the above-mentioned features are present, even asymptomatic patients should be closely monitored.

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Section: Discussioncontrasting

confidence: 59%

“…patients presented with luminal stenosis, either in the terminal ileum or other parts of the intestine [12]. In our two cases, the endoscope could pass through the ileocecal valve without resistance and other speci c ndings of intestinal tuberculosis, such as patulous ileocecal valve, were not observed [12][13].…”

Section: Discussionmentioning

confidence: 60%

Endoscopic features and clinical course of patients with asymptomatic cecal ulcers

Lin

Liao

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

Endoscopic features and clinical course of patients with asymptomatic cecal ulcers

et al. 2022

View full text Add to dashboard Cite

Background Cecal ulcers are sometimes encountered in asymptomatic individuals. Their clinical outcomes and management recommendations remain uncertain. Methods Asymptomatic patients who underwent a colonoscopic exam for colon cancer screening were retrospectively reviewed from July 2009 to November 2016. Patients with cecal ulcers were included. Patients who had colorectal symptoms, such as abdominal pain, had nonsteroidal anti-inflammatory drugs or were lost to follow-up were excluded. Results A total of 34,036 patients underwent colon cancer screening. Cecal ulcers were found in 35 patients. After exclusion, 24 patients (mean duration, 52 months) received follow-up colonoscopy. In 20 patients, (83.3%), cecal ulcer resolved without intervention, but 4 patients (16.7%) developed clinical significant diseases, including intestinal tuberculosis (n = 2), Crohn’s disease (n = 1), and ulcerative colitis (n = 1). Patients who developed clinically significant diseases had a higher percentage of ulcers larger than 1 cm (75% vs. 15%, p = 0.035), terminal ileum involvement (100% vs. 15.4%, p = 0.006) and ulcers with irregular fold (75% vs. 5%, p = 0.008). Conclusions In patients with asymptomatic cecal ulcers, the endoscopic features included larger ulcer size, terminal ileum involvement and ulcers with irregular fold may predict development of clinically significant diseases. If the above-mentioned features are present, even asymptomatic patients should be closely monitored.

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Difficulties in the differential diagnosis of intestinal tuberculosis and Crohn‘s disease

Reshetnikov

Plotkin

Zyuzya

et al. 2021

Acta biomedica scientifica

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The differential diagnosis of intestinal tuberculosis and Crohn’s disease is a difficult task for most specialists due to their high similarity in clinical manifestations, instrumental diagnosis and histological pattern.The aim: to consider the clinical and diagnostic features of intestinal tuberculosis and Crohn’s disease, to show the role of various methods of their diagnosis (CT of the abdominal cavity, CT-enterography, colonoscopy with biopsy).A clinical example shows a case illustrating the difficulties of diagnosing intestinal tuberculosis, initially diagnosed as Crohn’s disease. The features of the course, complex diagnosis and treatment of intestinal tuberculosis and its complications during immunosuppression are demonstrated. At the first stage of treatment, the patient’s data related to CT of the chest organs, colonoscopy and histological examination of biopsy samples were incorrectly interpreted. As a result, a wrong diagnosis of Crohn’s disease was made, and immunosuppressive therapy was prescribed that provoked a generalization of the existing tuberculosis process. Subsequently, repeated surgical interventions were performed for complications of intestinal tuberculosis – perforation of tuberculous ulcers, peritonitis. Based on the analysis of the literature data and our own observation, it is shown that granulomatous inflammation in the study of intestinal biopsies doesn’t always allow us to make a clear diagnosis, first of all, there are intestinal tuberculosis and Crohn’s disease in the differential diagnostic series. The use of histobacterioscopy according to Ziehl – Neelsen, the study of fecal matter by luminescent microscopy, as well as molecular genetic methods for detecting DNA MTB allow us to verify the diagnosis. If Crohn’s disease is misdiagnosed as intestinal tuberculosis, then the prescribed anti-tuberculosis therapy can cause harm and lead to a delay in the underlying disease treatment. The reverse misdiagnosis is potentially more dangerous: if tuberculosis is misdiagnosed as Crohn’s disease, then the appointment of immunosuppressive therapy can lead to the generalization of tuberculosis and the development of fatal complications.

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Endoscopic features and treatment response have better prediction rate than clinical symptoms/signs in distinguishing Crohn's disease and intestinal tuberculosis

Cited by 3 publications

References 29 publications

Endoscopic features and clinical course of patients with asymptomatic cecal ulcers

Endoscopic features and clinical course of patients with asymptomatic cecal ulcers

Endoscopic features and clinical course of patients with asymptomatic cecal ulcers

Difficulties in the differential diagnosis of intestinal tuberculosis and Crohn‘s disease

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