Is the rise in Crohn's disease in India accompanied by a fall in intestinal tuberculosis? A single-center experience

Dhoble, Pavan; Desai, Devendra; Abraham, Philip

doi:10.1016/j.ijtb.2020.08.010

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…The rising incidence of inflammatory bowel disease (IBD) in India does not seem to have reduced the numbers of GITB. Hence distinguishing the two continues to be a major challenge [37].…”

Section: Clinical Presentationmentioning

confidence: 99%

Evidence-based approach to diagnosis and management of abdominal tuberculosis

Jha

Pathiyil

Sharma

2023

Indian J Gastroenterol

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Abdominal tuberculosis is an ancient problem with modern nuances in diagnosis and management. The two major forms are tuberculous peritonitis and gastrointestinal tuberculosis (GITB), while the less frequent forms are esophageal, gastroduodenal, pancreatic, hepatic, gallbladder and biliary tuberculosis. The clinicians need to discriminate the disease from the close mimics: peritoneal carcinomatosis closely mimics peritoneal tuberculosis, while Crohn's disease closely mimics intestinal tuberculosis. Imaging modalities (ultrasound, computed tomography, magnetic resonance imaging and occasionally positron emission tomography) guide the line of evaluation. Research in diagnostics (imaging and endoscopy) has helped in the better acquisition of tissue for histological and microbiological tests. Although point-of-care polymerase chain reaction-based tests (e.g. Xpert Mtb/Rif) may provide a quick diagnosis, these have low sensitivity. In such situations, ancillary investigations such as ascitic adenosine deaminase and histological clues (granulomas, caseating necrosis, ulcers lined by histiocytes) may provide some specificity to the diagnosis. A diagnostic trial of antitubercular therapy (ATT) may be considered if all diagnostic armamentaria fail to clinch the diagnosis, especially in TB-endemic regions. Objective evaluation with clear endpoints of response is mandatory in such situations. Early mucosal response (healing of ulcers at two months) and resolution of ascites are objective criteria for early response assessment and should be sought at two months. Biomarkers, especially fecal calprotectin for intestinal tuberculosis, have also shown promise. For most forms of abdominal tuberculosis, six months of ATT is sufficient. Sequelae of GITB may require endoscopic balloon dilatation for intestinal strictures or surgical intervention for recurrent intestinal obstruction, perforation or massive bleeding.

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“…The rising incidence of inflammatory bowel disease (IBD) in India does not seem to have reduced the numbers of GITB. Hence distinguishing the two continues to be a major challenge [37].…”

Section: Clinical Presentationmentioning

confidence: 99%

Evidence-based approach to diagnosis and management of abdominal tuberculosis

Jha

Pathiyil

Sharma

2023

Indian J Gastroenterol

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“…The problem is further compounded at the sites that are affected by phenotypically similar but etiologically different disease processes, with the intestine (CD), thoracic cavity (sarcoidosis), and eyes (Eale's disease) primarily being such sites 5,6 . The epidemic of these immune‐mediated disorders, such as inflammatory bowel disease (IBD), has followed the decline of TB in the West, 2 marked by a rising incidence in the 20th century that has stabilized over the last decade, 7 while the developing world is following this pattern and is at the epidemiologic crossroads with a declining or stabilizing burden of TB 8,9 and a rising incidence of IBD and other such disorders 10–13 . Hence, the nontubercular etiologies at these extrapulmonary sites have largely replaced TB in the West, but the TB‐endemic regions continue to be affected by both the etiologies, creating a diagnostic challenge for clinicians in these regions.…”

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confidence: 99%

Intestinal tuberculosis or Crohn's disease: Illusion or delusion or allusion

Kedia

Ahuja

2021

JGH Open

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Interferon-gamma release assay has poor diagnostic accuracy in differentiating intestinal tuberculosis from Crohn’s disease in tuberculosis endemic areas

et al. 2023

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Background/Aims: Intestinal tuberculosis (ITB) and Crohn’s disease (CD) frequently present with a diagnostic dilemma because of similar presentation. Interferon-gamma release assay (IGRA) has been used in differentiating ITB from CD, but with sparse reports on its diagnostic accuracy in tuberculosis endemic regions and this study evaluated the same.Methods: Patients with definitive diagnosis of ITB (n=59) or CD (n=49) who underwent IGRA testing (n=307) were retrospectively included at All India Institute of Medical Sciences, New Delhi (July 2014 to September 2021). CD or ITB was diagnosed as per standard criteria. IGRA was considered positive at >0.35 IU/mL.Relevant data was collected and IGRA results were compared between ITB and CD to determine its accuracy.Results: Among 59 ITB patients (mean age, 32.6±13.1 years; median disease duration, 1 year; male, 59.3%), 24 were positive and 35 tested negative for IGRA. Among 49 CD patients (mean age, 37.8±14.0; median disease duration, 4 years; male, 61.2%), 12 were positive and 37 tested negative for IGRA. Hence, for diagnosing ITB, IGRA showed a sensitivity, specificity, positive and negative predictive values of 40.68%, 75.51%, 66.67%, and 51.39%, respectively. The area under the curve of IGRA for ITB diagnosis was 0.66 (95% confidence interval, 0.55–0.75). In a subset (n=64), tuberculin skin test (TST) showed sensitivity, specificity, positive and negative predictive values of 64.7%, 73.3%, 73.3%, and 64.71%, respectively. IGRA and TST were concordant in 38 (59.4%) patients with κ=0.17.Conclusions: In a tuberculosis endemic region, IGRA had poor diagnostic accuracy for differentiating ITB from CD, suggesting a limited value of IGRA in this setting.

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Is the rise in Crohn's disease in India accompanied by a fall in intestinal tuberculosis? A single-center experience

Cited by 3 publications

References 19 publications

Evidence-based approach to diagnosis and management of abdominal tuberculosis

Evidence-based approach to diagnosis and management of abdominal tuberculosis

Intestinal tuberculosis or Crohn's disease: Illusion or delusion or allusion

Interferon-gamma release assay has poor diagnostic accuracy in differentiating intestinal tuberculosis from Crohn’s disease in tuberculosis endemic areas

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