Granulomas as the Most Useful Histopathological Feature in Distinguishing between Crohn's Disease and Intestinal Tuberculosis in Endoscopic Biopsy Specimens

Ye, Ziyin; Lin, Yuan; Cao, Qinghua; He, Yao; Xue, Ling

doi:10.1097/md.0000000000002157

Cited by 39 publications

(28 citation statements)

References 29 publications

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“…However, the histological features of these two diseases have been found to be very similar in endoscopic biopsies. A recent study suggests that density, confluence and size are most useful distinguishing features of granulomas, and that the detection rate of granulomas is high in longitudinal ulcers on endoscopic biopsy specimens [23].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic features and treatment response have better prediction rate than clinical symptoms/signs in distinguishing Crohn's disease and intestinal tuberculosis

Lin

Chang

Wang

et al. 2017

Adv in Digestive Medicine

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Summary Background Intestinal tuberculosis (ITB) is less common than Crohn's disease (CD) in Taiwan. Despite the worldwide decline in TB incidence over last several years, the prevalence yet remains high. Therefore, there is a necessity to increase the clinical awareness of this serious health problem. The aim of this study was to investigate the value of clinical methods that may be helpful in distinguishing CD from ITB. Methods Eighty‐five patients, 67 and 18 patients diagnosed with CD and ITB, respectively, from January 2000 to April 2015 at Mackay Memorial Hospital, Taipei were included. The clinical, laboratory, endoscopic, and histological characteristics were reviewed retrospectively. Results CD patients (33 ± 13 years) were younger than ITB patients (57 ± 21 years) (p = 0.103). The incidences of hematochezia, abdominal pain, diarrhea, fever, and weight loss were not significantly different (p = 0.388, p = 0.699, p = 0.751, p = 0.468, and p = 0.611, respectively). The hemoglobin, platelet, and C‐reactive protein (CRP) levels were also not significantly different (p = 0.388, p = 0.440, and p = 0.330, respectively). The endoscopic features of aphthous ulcer and cobblestone appearance were seen more often in CD patients (p = 0.043 and p = 0.010, respectively). Rectal lesions (29.9 vs. 0%; p = 0.020) were seen only in CD patients. Patulous ileocecal valve was specifically seen in ITB patients (p = 0.006). The histological features of granuloma, cryptitis and crypt abscess, and fissure formation were not significantly different (p = 0.377, p = 0.293, and p = 0.212, respectively). Conclusions The endoscopic features of aphthous ulcerations, cobblestone appearance, and rectal involvement in CD and of patulous ileocecal valve in ITB, along with clinical treatment follow‐up, tend to be useful diagnostic characteristics differentiating CD and ITB. Copyright © 2017, The Gastroenterological Society of Taiwan, The Digestive Endoscopy Society of Taiwan and Taiwan Association for the Study of the Liver.

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Section: Discussionmentioning

confidence: 99%

Endoscopic features and treatment response have better prediction rate than clinical symptoms/signs in distinguishing Crohn's disease and intestinal tuberculosis

Lin

Chang

Wang

et al. 2017

Adv in Digestive Medicine

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“…Both are chronic granulomatous disorders and currently, majority of diagnoses are made on endoscopic mucosal biopsy specimens which may not show the characteristic caseation and acid-fast bacilli in intestinal tuberculosis or the fissuring ulcers and transmural inflammation in Crohn's disease. 2 Various imaging (plain x-rays, barium studies, ultrasonography, CT and Magnetic Resonance Imaging) and endoscopic modalities are available for detection and characterization of these bowel pathologies which along with histopathological and microbiological findings and response to empirical therapy complement each other in making a final diagnosis. 2,3 CT is often the initial imaging investigation performed for the evaluation of suspected bowel pathology.…”

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confidence: 99%

“…2 Various imaging (plain x-rays, barium studies, ultrasonography, CT and Magnetic Resonance Imaging) and endoscopic modalities are available for detection and characterization of these bowel pathologies which along with histopathological and microbiological findings and response to empirical therapy complement each other in making a final diagnosis. 2,3 CT is often the initial imaging investigation performed for the evaluation of suspected bowel pathology. However, conventional CT does not provide adequate distension of the bowel and the positive oral contrast only depicts bowel wall thickening, stricture, and dilatation, but not mucosal abnormality.…”

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confidence: 99%

Ct Enteroclysis / Ct Enterography for Differentiating Intestinal Tuberculosis From Crohn’s Disease

Alpana¹,

Yadav²,

Yadav³

et al. 2019

jebmh

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BACKGROUND Intestinal tuberculosis is highly prevalent in India and the incidence of Crohn's disease is also increasing. Both these diseases have similar clinical presentation, imaging and pathological features. This makes differentiation between these two entities challenging. Differentiating these entities is important because there is a considerable difference in their management. CT enteroclysis (CT-EC) and CT enterography (CT-EG) are newer imaging techniques which provide good luminal distention of the bowel and allow better detection of bowel wall lesions, their pattern of enhancement and also detect extra-intestinal findings in the abdomen. The aim of this study was to evaluate the role of CT-EC/CT-EG in the detection, characterization and differentiation of intestinal tuberculosis and Crohn's disease. METHODS One hundred and fifty patients with clinically suspected intestinal tuberculosis or Crohn's diseases were subjected to CT-EC/CT-EG. Findings on CT-EC/CT-EG were correlated with other investigations (radiological, endoscopic, histopathological, microbiological, body fluid examination) and improvement on empirical therapy. RESULTS Seventy-nine patients had bowel lesions based on findings on CT-EC/CT-EG and other investigations of which 47, 18 and 14 patients had final diagnoses of intestinal tuberculosis, Crohn's disease and other bowel lesions (ulcerative colitis, duodenal ulcers, strictures of undetermined aetiology, parasitic infections and appendicitis) respectively. The sensitivity of CT-EC/CT-EG for detecting bowel involvement in intestinal tuberculosis and Crohn's disease was 91.48% and 94.44% respectively. Contiguous involvement of terminal ileum, ileo-cecal junction and adjacent colon, homogenous enhancement of bowel wall thickening, and abdominal lymphadenopathy were significantly more common in intestinal tuberculosis while jejunal involvement, mural stratification pattern of enhancement, strictures, skip lesions, mesenteric fat stranding and increased mesenteric vascularity were significantly commoner in Crohn's disease. Associated calcified and necrotic abdominal lymphadenopathy, cocoon formation and vertebral involvement were specific to intestinal tuberculosis. CONCLUSIONS CT-EC/CT-EG are sensitive investigations for detection of bowel lesions in intestinal tuberculosis and Crohn's disease. No site of bowel involvement or pattern of enhancement of bowel wall thickening is specific to intestinal tuberculosis or Crohn's disease. However, associated extra-intestinal findings on CT-EC/CT-EG and findings on other investigations can help differentiate between intestinal tuberculosis and Crohn's disease.

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“…In those cases, the pathological findings reevaluated by a pathologist from our hospital are described in the results. Large granuloma was defined as a maximum diameter of the largest granuloma >400 μm in the reevaluated cases (15,16).…”

Section: Pathological Analysismentioning

confidence: 99%

Ten Cases of Intestinal Tuberculosis Which Were Initially Misdiagnosed as Inflammatory Bowel Disease

et al. 2019

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Objective Intestinal tuberculosis (ITB) and inflammatory bowel disease (IBD) frequently present with similar clinical, endoscopic and pathological features, therefore it is difficult to differentiate between them. The aim of this study was to elucidate the diagnostic delay and prognosis of ITB cases, initially misdiagnosed as IBD. Methods ITB cases were selected from the hospitalized patient list between April 2004 and March 2017 in a tuberculosis center in Japan. We retrospectively evaluated the initial diagnosis, clinical characteristics, endoscopic and pathological findings, bacterial examinations, treatment and prognosis. Results Among 66 ITB patients, ten patients were initially misdiagnosed as IBD. Seven patients were male and the median age was 60.5 years (23-74 years). After the diagnosis of IBD, all the patients were treated with mesalazine, in addition to corticosteroids in two patients and sequential azathioprine and infliximab in one. The median duration of diagnostic delay was 5.5 months (range 0.5-17 months). Eight patients had active pulmonary tuberculosis at the diagnosis of ITB. Acid-fast bacilli were confirmed in four of seven patients by reevaluation of the pathological specimens at the IBD diagnosis. Two patients needed intestinal resection and one with erroneous corticosteroid use for IBD died due to respiratory failure in spite of receiving appropriate treatment for tuberculosis. Conclusion ITB patients were frequently misdiagnosed and treated as IBD, thus resulting in a poor clinical outcome even after finally making a correct diagnosis and administering appropriate treatment. On diagnosis of IBD and/or treatment failure, chest radiograph and acid-fast bacilli of the pathological specimens should be carefully evaluated in order to rule out tuberculosis.

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Granulomas as the Most Useful Histopathological Feature in Distinguishing between Crohn's Disease and Intestinal Tuberculosis in Endoscopic Biopsy Specimens

Cited by 39 publications

References 29 publications

Endoscopic features and treatment response have better prediction rate than clinical symptoms/signs in distinguishing Crohn's disease and intestinal tuberculosis

Endoscopic features and treatment response have better prediction rate than clinical symptoms/signs in distinguishing Crohn's disease and intestinal tuberculosis

Ct Enteroclysis / Ct Enterography for Differentiating Intestinal Tuberculosis From Crohn’s Disease

Ten Cases of Intestinal Tuberculosis Which Were Initially Misdiagnosed as Inflammatory Bowel Disease

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