Endoscopic mucosal biopsies are useful in distinguishing granulomatous colitis due to Crohn's disease from tuberculosis

Pulimood, Anna; Ramakrishna, B. S.; Kurian, George; Peter, Shajan; Patra, Susama; Mathan, V. I.; Mathan, M.

doi:10.1136/gut.45.4.537

Cited by 193 publications

(120 citation statements)

References 20 publications

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“…Indian migrants in Western countries have shown increased incidence of IBD, more so in the second generation of immigrants [1,5] . In India, the incidence of UC has significantly increased over the last three decades, whereas the incidence of CD increased progressively in the last decade [4,[6][7][8][9][10][11][12][13][14][15] . Tuberculosis (TB) remains widely prevalent in developing countries such as India.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of Crohn’s disease in India where tuberculosis is widely prevalent

Amarapurkar

Patel²,

Rane³

2008

WJG

154

121

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AIM:To define the parameters that positively predict diagnosis of Crohn's disease (CD) and differentiate it from gastrointestinal tuberculosis (GITB). METHODS:This prospective study over 3 years was carried out in the consecutive Indian patients with definite diagnosis of CD and equal numbers of patients with definite diagnosis of GITB. Demographic, clinical, laboratory, morphological and histological features were noted in all the patients. Serological tests such as p-ANCA, c-ANCA, IgA ASCA and IgG ASCA, were performed. Endoscopic biopsy and/or surgical tissue specimens were subjected to smear and culture for acid-fast bacilli (AFB) and tissue polymerase chain reaction for tuberculosis (TB PCR). Diagnosis of CD and GITB was based on the standard criteria. Data were analyzed using univariate Chi-square test and multiple logistic regression (MLR). RESULTS:The study is comprised of 26 patients with CD (age 36.6 ± 8.6 year, male:female, 16:10) and 26 patients with GITB (age 37.2 ± 9.6 year, male:female, 15:11). The following clinical variables between the two groups (CD vs TB) were significant in univariate analysis: duration of symptoms (58.1 ± 9.8 vs 7.2 ± 3.4 mo), diarrhoea (69.2% vs 34.6%), bleeding per rectum (30.7% vs 3.8%), fever (23.1% vs 69.2%), ascites (7.7% vs 34.6%) and extra-intestinal manifestations of inflammatory bowel disease (61.5% vs 23.1%). Of these, all except ascites and extra-colonic manifestations were found statistically significant by MLR. Accuracy of predicting CD was 84.62% based on the fever, bleeding P/R, diarrhoea and duration of symptoms while it was 63.4% when histology was reported as inflammatory bowel disease and 42.3% when there was recurrence of disease after surgery. Accuracy of predicting GITB was 73.1% when there was co-existing pulmonary lesions and/or abdominal lymphadenopathy; 75% when tuberculosis was reported in histology; 63.4% when granuloma was found in histology; 82.6% when TB PCR was positive; and 61.5% when smear and/ or culture was positive for AFB. Serological test was not useful in differentiation of CD from GITB. Positivity rates for CD and GITB were: p-ANCA-3.8% and 3.8%, c-ANCA-3.8% and 0%, IgA ASCA-38.4% and 23.1%, and IgG ASCA-38.4% and 42.3%, respectively. CONCLUSION:Simple clinical parameters like fever, bleeding P/R, diarrhoea and duration of symptoms have the highest accuracy in differentiating CD from GITB.

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Section: Introductionmentioning

confidence: 99%

Diagnosis of Crohn’s disease in India where tuberculosis is widely prevalent

Amarapurkar

Patel²,

Rane³

2008

WJG

154

121

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“…Caseation necrosis in granulomas is also diagnostic of tuberculosis in this setting. In two series from southern India, caseation necrosis was found in mucosal biopsies from 20 to 53 patients with intestinal tuberculosis compared to 0 of 51 patients with CD [29,30]. In a series from northern India, caseation necrosis in mucosal biopsies was found in 7 of 53 patients with intestinal tuberculosis compared to 1 of 53 patients with CD [33].…”

Section: Tb-pcr Of Biopsies Does Not Reliably Discriminate Intestinalmentioning

confidence: 99%

“…In three Indian studies, mucosal biopsy findings of large granulomas, greater than 400 μ in diameter, was noted in 0 % to 9.4 % of patients with CD compared to 27 % to 90 % of patients with intestinal tuberculosis [29,30,33]. In these studies, confluent granulomas were recorded in 0 % to 3 % of CD biopsies compared to 42 % to 60 % in tuberculosis.…”

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confidence: 95%

“…It requires to be based on a combination of clinical presentation, endoscopy, imaging, histology, and if possible examination of an operative specimen [28]. Microscopic features are much better assessed on surgical pathology of resected specimens, but there may be a number of clues to the diagnosis on mucosal biopsies obtained during endoscopy [29,30]. In the Western setting, the difficulty usually lies in distinguishing between Crohn's colitis and ulcerative colitis, and 5 % to 10 % of patients may shift between categories in the first few years after diagnosis [31].…”

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confidence: 99%

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Indian Society of Gastroenterology consensus statements on Crohn’s disease in India

Ramakrishna

Makharia

Ahuja

et al. 2015

Indian J Gastroenterol

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In 2012, the Indian Society of Gastroenterology's Task Force on Inflammatory Bowel Diseases undertook an exercise to produce consensus statements on Crohn's disease (CD). This consensus, produced through a modified Delphi process, reflects our current recommendations for the diagnosis and management of CD in India. The consensus statements are intended to serve as a reference point for teaching, clinical practice, and research in India.

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“…[4] In geographical regions where both Crohn's colitis and tuberculosis are prevalent, the differential diagnosis of the granulomatousileocolitis poses a challenge.Endoscopic mucosal biopsy specimens obtained through fiberopticsigmoidoscopes or colonoscopes from rectum, different areas of colon, ileocaecal valveand terminal ileum provides the possibility of histological conformation of the diagnosis of tuberculousileocolitis (TEC) or Crohn's disease in suspected early cases. [5] Colonoscopy has assumed a pivotal role in the diagnosis and management of patients with Inflammatory bowel disease (IBD). [6] Congenital disorder i.e.…”

Section: Introductionmentioning

confidence: 99%

Histomorphological Profile of Colonoscopic Biopsies - A Two Year Study in a Tertiary Care Hospital in South India

2016

IJSR

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Endoscopic mucosal biopsies are useful in distinguishing granulomatous colitis due to Crohn's disease from tuberculosis

Cited by 193 publications

References 20 publications

Diagnosis of Crohn’s disease in India where tuberculosis is widely prevalent

Diagnosis of Crohn’s disease in India where tuberculosis is widely prevalent

Indian Society of Gastroenterology consensus statements on Crohn’s disease in India

Histomorphological Profile of Colonoscopic Biopsies - A Two Year Study in a Tertiary Care Hospital in South India

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