Tubercular Intestinal Strictures Show a Poor Response to Anti-Tuberculous Therapy

Aggarwal, Piyush; Kedia, Saurabh; Sharma, Raju; Bopanna, Sawan; Madhusudhan, Kumble Seetharama; Yadav, Dhananjay; Goyal, Sandeep; Jain, Saransh; Mouli, Venigalla Pratap; Das, Prasenjit; Dattagupta, S; Makharia, Govind; Ahuja, Vineet

doi:10.1007/s10620-017-4727-3

Cited by 25 publications

(26 citation statements)

References 16 publications

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“…In this series, it was found that peritoneum was involved in around 46% while intestine was involved in around 36% of cases. This is different from other recent studies from northern India where intestine was the most common site [25], [27]. The response of peritoneal tuberculosis to ATT is very good as there was complete resolution in all the cases.…”

Section: Discussioncontrasting

confidence: 95%

“…However the surgeries are conservative and show very good results. A recent study from AIIMS, Delhi has shown that around 40% of intestinal tuberculosis [ITB] had stricturing disease and only one-fourth of strictures show resolution following ATT [27]. The resolution of strictures is dependent on disease location, duration and severity of stricture.…”

Section: Discussionmentioning

confidence: 99%

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Abdominal tuberculosis in Indians: Still very pertinent

Singh

Sahu

Panigrahi

et al. 2019

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

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IntroductionTuberculosis is a disease that has been affecting mankind since time immemorial and it still continues to be a global health concern. Objective of the study was to evaluate the burden, clinical profile, diagnosis and diagnostic difficulties and outcome of abdominal tuberculosis (AbT) in non human immunodeficiency virus (HIV) infected adults in the department of gastroenterology at a tertiary care hospital over a period of two years.Material & methodsIt was an observational study and the study period was from January 2016 till January 2018. The patients who were sero positive for HIV virus were excluded from the study.ResultsThe number of patients hospitalized during the period of 2016–2018 with abdominal tuberculosis was 58. The burden of tuberculosis of indoor patients was 1.3 cases per every 100 patients admitted. Presenting complaint of most of these patients [61%] was abdominal pain. Constitutional symptoms like fever; weight loss and loss of appetite were present in only 40% of the patients. Ascites was the presenting sign in around 45% of the patients. Peritoneum was the most common site of involvement [27 out of 58]. Almost all of these patients [25 out of 27] presented with abdominal pain and abdominal distension. Intestine was the second most common site. Ileocaecal involvement was present in fourteen patients, while other areas of colon were involved in five patients. All the 58 patients were given anti tubercular therapy. There was complete resolution of tuberculosis in 91% of cases [53 out of 58 patients]. Six patients developed drug induced liver injury. Death occurred in two patients who had disseminated tuberculosis.ConclusionAlthough the burden of the disease remains the same, availability of newer investigations has aided in its early diagnosis and availability of good drugs has reduced the mortality and morbidity.

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Section: Discussioncontrasting

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Abdominal tuberculosis in Indians: Still very pertinent

Singh

Sahu

Panigrahi

et al. 2019

Journal of Clinical Tuberculosis and Other Mycobacterial Diseas

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“…A recent study from AIIMS, Delhi has shown that around 40% of intestinal tuberculosis had stricturing disease and only one-fourth of strictures show resolution following AKT. 10 The resolution of stricture is dependent on disease location, duration and severity of stricture. The present series showed strictures in seven out of 24 confirmed patients with intestinal tuberculosis (28%).…”

Section: Drug Induced Hepatitis Discussionmentioning

confidence: 99%

A retrospective observational study of clinical profile, diagnosis, management and outcome of abdominal tuberculosis in 30 patients

et al. 2020

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Background: Abdominal tuberculosis is found worldwide although prevalence rates are still highest in the developing countries. The sites of involvement of abdominal tuberculosis are peritoneum, lymph nodes, intestine and solid viscera. The objectives of this study were to describe the clinical profile of patients with abdominal tuberculosis, to review the use of diagnostic modalities, both non-invasive and invasive and to study the outcome of management of abdominal tuberculosis.Methods: This is an observational retrospective study of 30 patients with diagnosis of abdominal tuberculosis treated at university linked teaching hospital of South Gujarat from August 2015 to November 2017.Results: In our study, disease was found almost equally prevalent in both rural and urban areas affecting mostly lower socio-economical class. The mean age was 34 years (range from 13 to 62); male and female ratio was 2.33:1; the mean hospital stay was 09 days (range from 5 to 48 days). Abdominal pain was present in almost all cases, having chronic pain in 21 patients and acute in 9 patients. There were 05 (16.7%) patients found to be HIV positive in this study. There was mortality of 02 patients post operatively due to sepsis in those patients operated in emergency with peritonitis.Conclusions: Abdominal tuberculosis is prevalent in lower socioeconomic class patients and affects younger male patients more commonly. Most commonly intestinal and mesenteric disease presented with chronic abdominal pain and constitutional symptoms of tuberculosis.

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“…Whether tuberculous strictures resolve with antitubercular treatment (ATT) or not is controversial. A few studies state that the symptoms abate, but strictures remain in most patients [ 3 4 ]. Patel and Yagnik suggested that most intestinal tuberculous lesions, including strictures, resolve with ATT, suggesting that strictures are inflammatory rather than fibrotic [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Surgical management of abdominal tuberculosis

Barot¹,

Yagnik²,

Patel³

et al. 2021

Tzu Chi Medical Journal

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Objective: Tuberculosis (TB) can affect any part of the gastrointestinal tract. It is estimated that in 2018, 10 million people were affected with TB worldwide and there were 1.2 million TB deaths among human immunodeficiency virus-negative people. India has the highest TB burden in the world (27%), a significant proportion of which are of intestinal TB. The aims of this study were to assess clinical features and investigations for the diagnosis of abdominal TB and to analyze its various surgical manifestations and its management. Materials and Methods: From October 1, 2014, to October 30, 2016, a total of 50 patients meeting the inclusion criteria for the study, age between 15 and 65 years and diagnosis of symptomatic intestinal TB requiring surgery, were enrolled in the study. We used descriptive statistics to analyze the data. Results: Abdominal TB was most commonly seen in young adults. Intestinal obstruction was the most frequent presentation. The most common site of involvement in the present study was the ileum. Ultrasonography (USG) and X-ray were an integral part of the diagnosis, with computed tomography (CT) scan being rarely required. Although both anemia and erythrocyte sedimentation rate (ESR) are nonspecific, they may help in supporting the clinical and pathological findings. Most operations were elective, with intestinal obstruction being the most common indication and resection and end-to-end anastomosis performed most often. Histopathological examination was performed in all patients and showed caseating granuloma in 90% of cases, while 10% of cases had chronic noncaseating granulomas with ill-defined aggregates of epithelioid histiocytes. Conclusion: Abdominal TB causes a significant problem in diagnosis due to nonspecific symptomatology and lack of specific laboratory tests. USG and X-ray were an integral part of the diagnosis. CT scan is rarely required. Although anemia and ESR are both nonspecific features, they may help in supporting the clinical and pathological findings. The most common site of involvement in the present study was the ileum. Intestinal obstruction was the most common indication for operation, with resection and end-to-end anastomosis being the most common operation. The mainstay of treatment is medical therapy and timely surgical intervention is required in a sizable number of patients.

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Tubercular Intestinal Strictures Show a Poor Response to Anti-Tuberculous Therapy

Abstract: Only one-fourth of ITB patients with strictures show resolution of stricture following ATT. The resolution of strictures is dependent on disease location, and majority of them exhibit symptoms pertaining to stricture even after ATT.

Cited by 25 publications

References 16 publications

Abdominal tuberculosis in Indians: Still very pertinent

Abdominal tuberculosis in Indians: Still very pertinent

A retrospective observational study of clinical profile, diagnosis, management and outcome of abdominal tuberculosis in 30 patients

Surgical management of abdominal tuberculosis

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