Summary
Background
Differentiation between intestinal tuberculosis and Crohn's disease is difficult and may require therapeutic trial with anti‐tubercular therapy in tuberculosis‐endemic regions.
Aim
To evaluate the role of therapeutic trial with anti‐tubercular therapy in patients with diagnostic confusion between intestinal tuberculosis and Crohn's disease.
Methods
We performed retrospective‐comparative (n = 288: 131 patients who received anti‐tubercular therapy before being diagnosed as Crohn's disease and 157 intestinal tuberculosis patients) and prospective‐validation study (n = 55 patients with diagnostic confusion of intestinal tuberculosis/Crohn's disease). Outcomes assessed were global symptomatic response and endoscopic mucosal healing.
Results
In the derivation cohort, among those eventually diagnosed as Crohn's disease, global symptomatic response with anti‐tubercular therapy was seen in 38% at 3 months and in 37% who completed 6 months of anti‐tubercular therapy. Ninety‐four per cent of intestinal tuberculosis patients showed global symptomatic response by 3 months. Endoscopic mucosal healing was seen in only 5% of patients with Crohn's disease compared with 100% of intestinal tuberculosis patients. In the validation cohort, all the patients with intestinal tuberculosis had symptomatic response and endoscopic mucosal healing after 6 months of anti‐tubercular therapy. Among the patients with an eventual diagnosis of Crohn's disease, symptomatic response was seen in 64% at 2 months and in 31% who completed 6 months of anti‐tubercular therapy, none had mucosal healing.
Conclusions
Disproportionately lower mucosal healing rate despite an overall symptom response with 6 months of anti‐tubercular therapy in patients with Crohn's disease suggests a need for repeat colonoscopy for diagnosing Crohn's disease. Patients with intestinal tuberculosis showing significant symptomatic response after 2–3 months of anti‐tubercular therapy, suggest that symptom persistence after a therapeutic trial of 3 months of anti‐tubercular therapy may indicate the diagnosis of Crohn's disease.
This population-based study in a high altitude area in India suggests a high prevalence (18.7%) of GERD. A younger age group, sedentary lifestyle, serum LDL >150 mg/dL, high consumption of meat, low consumption of salted tea and low consumption of fresh fruits were significant risk factors for development of GERD.
The high specificity of FISH polysomy/9p21 suggests that a positive result is sufficient for diagnosing malignancy in indeterminate strictures. The significantly higher sensitivity of FISH polysomy/9p21 compared to cytology supports the use of FISH in all non-diagnostic cases. Although both EUS-FNA and CBx were complimentary, our results suggest that distal strictures should be evaluated by EUS initially. Proximal strictures may be evaluated by FISH first and then by CBx if inconclusive.
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