Clinical, Endoscopic and Histological Differentiations between Crohn’s Disease and Intestinal Tuberculosis

Abstract

Background and Aim: Differentiating Crohn’s disease from intestinal tuberculosis often challenges clinicians in countries where tuberculosis and Crohn’s disease coexist. The aim of this study was to screen out clinical, endoscopic and histological features which may be helpful in distinguishing Crohn’s disease from intestinal tuberculosis. Methods: 43 patients with a confirmed diagnosis of intestinal tuberculosis and 53 patients with Crohn’s disease were recruited for this study. Their clinical, endoscopic and histological features were subjected to univariate and multivariate analyses. Results: On univariate analysis, the features of hematochezia, intestinal obstruction, fistula, oral ulcers, longitudinal ulcers, cobblestone appearance and pseudopolyps were more common in Crohn’s disease than in intestinal tuberculosis (p < 0.05). The features of night sweats, concomitant pulmonary tuberculosis, positive tuberculin skin test, positive antibody to tuberculosis, abdominal lymphadenopathy, ascites, transverse ulcers, patulous ileocecal valve, and granulomas were more common in intestinal tuberculosis than in Crohn’s disease (p < 0.05). Granulomas exceeding 300 µm in maximal diameter, more than five granulomas per section, and confluent granulomas were more frequently identified in intestinal tuberculosis than in Crohn’s disease (p < 0.05). On further multivariable logistic regression analysis, night sweats (OR 0.1, CI 0.02–0.1), longitudinal ulcers (OR 35.5, CI 1.8–683.2), and granulomas (OR 0.02, CI 0.002–0.2) were found to be significant predictors in differentiating Crohn’s disease from intestinal tuberculosis. Receiver-operating characteristic (ROC) analysis was performed on the scores of patients from the final multivariate logistic model, and the area under the ROC curve was 0.8642 (95% CI 0.79–0.94). Conclusions: Night sweats, longitudinal ulcers and granulomas were the most important features to differentiate Crohn’s disease from intestinal tuberculosis.

Fluorescent quantitative PCR of Mycobacterium tuberculosis for differentiating intestinal tuberculosis from Crohn's disease

“…There are many proposed clinical, radiological, endoscopic, and histological features that distinguish ITB from CD, including a prolonged illness, diarrhea, hematochezia, weight loss, extraintestinal manifestations, fever, ascites, deep linear ulcers, cobble-stone appearance, involvement of the sigmoid colon, coexisting pulmonary lesions, and abdominal lymphadenopathy, etc. (20-22). In the present study, perianal disease and longitudinal ulcers were more common in the CD patients, whereas night sweats, ascites, and circumferential ulcers were more common in the ITB patients.…”

Crohn’s disease, tuberculosis or NSAID-induced colopathy: a case reportCrohn’s disease, tuberculosis or NSAID-induced colopathy: a case report

“…Intestinal tuberculosis (TBC) and colopathy induced by non-steroidal anti-inflammatory drug (NSAID) can mimic Crohn's disease (CD) and thus can cause diagnostic difficulties (1,2).…”

“…Several studies showed that CD and TBC overlap in clinical, endoscopic and histological features (2)(3)(4). Sacroiliitis (SI) is one of the most frequent extraintestinal manifestations in patients with inflammatory bowel disease (IBD) and can complicate medical behavior (5).…”

“…Sacroiliitis (SI) is one of the most frequent extraintestinal manifestations in patients with inflammatory bowel disease (IBD) and can complicate medical behavior (5). Longitudinal ulcers are typical for CD, but can also be seen in patients with intestinal TBC and NSAID-induced colopathy (1,2). In addition, some of the gut erosions, ulcers and strictures in CD are very similar to that caused by NSAID (1).…”

“…Caseous necrosis is an important histological feature of TBC, but in some studies it was found in only 13.3% of patients with gut TBC (2). Tuberculous SI is an uncommon variant of joint tuberculosis and mostly case reports are communicated (6).…”