Differential Diagnosis of Intestinal Tuberculosis from Crohn’s Disease: A Diagnostic Dilemma
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2018, Vol 6, Issue 4
Abstract
Background: In geographical regions where both intestinal tuberculosis (ITb) and Crohn’s disease (CD) coexist, the differential diagnosis of these two conditions poses a challenge to clinicians, because of similar clinical, radiological, and endoscopic findings, and hence, there are high rates of misdiagnosis in both conditions. Methods: A total of 345 cases of gastrointestinal (GI) endoscopic biopsies and resected specimens were received during the period January 2009–June 2011. Of the cases, 40 were clinically suspected to be suffering from Tb. These cases were analyzed with clinical, endoscopic, radiological, and pathological findings used acid-fast bacilli stain and culture along with newer ancillary techniques such as polymerase chain reaction (PCR) for Mycobacterium tuberculosis DNA and anti-Saccharomyces cerevisiae antibody (ASCA): ASCA - IgG and IgA for CD. Results: Of 40 clinically suspected patients, 20 (50%) were suffering from Tb, 4 (10%) from CD, 8 (20%) from ischemic enteritis, 6 (15%) from chronic non-specific enteritis, 1 (2%) from adenocarcinoma cecum, and 1 (2%) from inflammatory fibroid polyp. Conclusions: ASCA test was not found useful in differentiating CD from GITb. Tissue PCR was most reliable technique to confirm GITb. Serological assay is used to some extent, and it is sensitive when IgG and IgA are combined. The best way to diagnose CD, is by exclusion of GITb and to correlate histology with clinical finding.
Authors and Affiliations
G Monika, K Nikhilesh
Keywords
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