Predictors of Clinical and Endoscopic Findings in Differentiating Crohn’s Disease from Intestinal Tuberculosis

Li, Xuefeng; Liu, Xiaowei; Zou, Yiyou; Ouyang, Chunhui; Wu, Xiaoping; Zhou, Minjie; Chen, Lin Lin; Ye, Lingjuan; Lu, Fanggen

doi:10.1007/s10620-010-1231-4

Cited by 53 publications

(74 citation statements)

References 19 publications

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“…The clinical features favoring CD included hematochezia, fistula, intestinal obstruction and oral ulcers, and the clinical features favoring ITB included night sweats and abdominal lymphadenopathy. These findings are similar to other reports [11,15]. …”

Section: Discussionsupporting

confidence: 93%

“…A proportion of patients with CD can be positive for their tuberculin test because of cross-reaction with bacillus Calmette-Guérin (BCG) [16], which is widely given to people at birth in China as routine vaccination. Positive antibody to tuberculosis favored the diagnosis of ITB but lacked sensitivity in this study, which was also similar to other reports [15]. …”

Section: Discussionsupporting

confidence: 92%

“…Patel et al [3] reported that 21% of gastrointestinal tuberculosis cases had extraluminal tuberculosis. A recent study from China found that 31.9% of patients with ITB had concomitant pulmonary tuberculosis [15]. In our study, pulmonary tuberculosis infiltration was found in 62.8% of patients with ITB.…”

Section: Discussionsupporting

confidence: 61%

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

Liu

Wang

et al. 2012

Digestion

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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.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 92%

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

Liu

Wang

et al. 2012

Digestion

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“…Disease manifestation depends on the site of lesion in the gastrointestinal tract, although general signs such as fever, weight loss, cachexia and diarrhoea and symptoms of abdominal pain and malaise are usually present. [2][3][4][5][6][7][8] However, the presentation and pathological findings of ITB may vary and be non-specific, and the disease may easily be confounded with other gastrointestinal diseases. 9 Gastrointestinal endoscopic examination plays a key role in the diagnosis of ITB.…”

mentioning

confidence: 99%

Faecal calprotectin levels differentiate intestinal from pulmonary tuberculosis: An observational study from Southern India

Larsson

Shenoy²,

Ramasubramanian

et al. 2014

UEG Journal

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“…A Chinese study consisting of 122 cases of ITB and 130 cases of CD developed a regression mathematical equation according to the endoscopic parameters as follow: rectum involvement, longitudinal ulcers, transverse ulcers, rodent-like ulcers, cobblestone sign, and fixedopen ileocecal valve ( fig. 1 a, b) [8] . To some extent, the colonoscopic features are poor-defined and subjective to the practitioner.…”

Section: Introductionmentioning

confidence: 99%

The Challenge of Inflammatory Bowel Disease Diagnosis in Asia

Qian²

2016

Inflamm Intest Dis

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Background: The current major clinical challenge relates to the accurate diagnosis of inflammatory bowel disease (IBD) in Asian countries with a high background prevalence of infections. Summary: The diagnosis of Crohn's disease in geographical areas where tuberculosis is endemic poses a major diagnostic challenge. Key Messages: Infections can mimic IBD and complicate the course of existing IBD. Limited availability of diagnostic modalities and health service may delay diagnosis. A multidisciplinary approach, continuous medical education, and academic activities may warrant an accurate diagnosis of IBD.

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Predictors of Clinical and Endoscopic Findings in Differentiating Crohn’s Disease from Intestinal Tuberculosis

Abstract: It was proposed that a diagnostic algorithm based on available clinical and endoscopic regression equation could improve the current sensitivity, specificity, and accuracy in differentiating between CD from ITB.

Cited by 53 publications

References 19 publications

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

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

Faecal calprotectin levels differentiate intestinal from pulmonary tuberculosis: An observational study from Southern India

The Challenge of Inflammatory Bowel Disease Diagnosis in Asia

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