Intestinal Tuberculosis: An Overview

Kedia, Saurabh; Ahuja, Vineet

doi:10.1007/978-981-16-9053-2_6

Cited by 2 publications

(3 citation statements)

References 113 publications

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“…The clinical presentation of intestinal TB is dominated by abdominal pain (30% to 88%), fever (21% to 73%), diarrhea (5% to 47%), loss of appetite (30% to 90%), loss of weight (8% to 80%), constipation (7% to 24%), and hematochezia (5% to 15%). Some patients may present with intestinal obstruction (3% to 36%) [35]. Concomitant or past pulmonary TB could be present in up to 25% of cases [36].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…TB culture provides an important tool for the diagnosis of GITB and also helps in testing for drug sensitivity in appropriate clinical settings. Culture positivity has been reported to vary from 7% to 79%, but is usually less than 50% [35]. MGIT may be preferable to the traditional culture in the Lowenstein-Jensen medium [57].…”

Section: Microbiologymentioning

confidence: 99%

“…Usually, endoscopic dilatation is safe and efficacious [62]. Indirect evidence from CD-related strictures suggests a dilatation of 15-18 mm and passability of a standard colonoscope as additional criteria, but these have not been validated in the setting of GITB [35]. Strictures in GITB are likely to behave differently from CD-related strictures because effective ATT would ensure the absence of ongoing inflammation and therefore, the effects of dilatation may be more lasting.…”

Section: Endoscopic Interventions and Surgerymentioning

confidence: 99%

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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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Section: Clinical Presentationmentioning

confidence: 99%

Section: Microbiologymentioning

confidence: 99%

Section: Endoscopic Interventions and Surgerymentioning

confidence: 99%

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Evidence-based approach to diagnosis and management of abdominal tuberculosis

Jha

Pathiyil

Sharma

2023

Indian J Gastroenterol

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Differentiating gastrointestinal tuberculosis and Crohn's disease- a comprehensive review

et al. 2023

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Gastrointestinal Tuberculosis (GITB) and Crohn’s disease (CD) are both chronic granulomatous diseases with a predilection to involve primarily the terminal ileum. GITB is often considered a disease of the developing world, while CD and inflammatory bowel disease are considered a disease of the developed world. But in recent times, the epidemiology of both diseases has changed. Differentiating GITB from CD is of immense clinical importance as the management of both diseases differs. While GITB needs anti-tubercular therapy (ATT), CD needs immunosuppressive therapy. Misdiagnosis or a delay in diagnosis can lead to catastrophic consequences. Most of the clinical features, endoscopic findings, and imaging features are not pathognomonic for either of these two conditions. The definitive diagnosis of GITB can be clinched only in a fraction of cases with microbiological positivity (acid-fast bacilli, mycobacterial culture, or PCR-based tests). In most cases, the diagnosis is often based on consistent clinical, endoscopic, imaging, and histological findings. Similarly, no single finding can conclusively diagnose CD. Multiparametric-based predictive models incorporating clinical, endoscopy findings, histology, radiology, and serology have been used to differentiate GITB from CD with varied results. However, it is limited by the lack of validation studies for most such models. Many patients, especially in TB endemic regions, are initiated on a trial of ATT to see for an objective response to therapy. Early mucosal response assessed at two months is an objective marker of response to ATT. Prolonged ATT in CD is recognized to have a fibrotic effect. Therefore, early discrimination may be vital in preventing the delay in the diagnosis of CD and avoiding a complicated course.

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Intestinal Tuberculosis: An Overview

Cited by 2 publications

References 113 publications

Evidence-based approach to diagnosis and management of abdominal tuberculosis

Evidence-based approach to diagnosis and management of abdominal tuberculosis

Differentiating gastrointestinal tuberculosis and Crohn's disease- a comprehensive review

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