Distinguishing Crohn’s disease from intestinal tuberculosis – a prospective study.
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Date
2010-07
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Abstract
Background: Distinguishing Crohn’s disease (CD) from intestinal tuberculosis (ITB) is clinically challenging but important for prognostication and patient management.
Methods: Patients with diagnosis of CD and ITB were prospectively enrolled in the study
from January 2006 to October 2007. The patients were followed up for further 15 months to
ascertain that the diagnosis had not changed. Clinical, laboratory, serological [IgG anti
Saccharomyces cerevisiae antibody (ASCA)], endoscopic and histologic features were
compared between the ITB and CD patients. The ASCA titers were estimated in 100 healthy
controls. Patients were diagnosed as ASCA positive when their ASCA titers were three standard
deviations above mean of controls.
Results: Thirty patients with CD (age 33.9 + 15.2 years, 70% males) and thirty with ITB (age
35.1 + 12.2years, 53.3% males) were included in the study. Features commoner in CD were
longer duration of symptoms (p<0.001), blood mixed stool (p=0.006), presence of longitudinal
ulcers (p=0.005) and skip lesions (p=0.008) on colonoscopy and more number of colonic
segments involved (p=0.004). Anorexia was commoner in ITB patients (p=0.008). Positive
ASCA was commoner in CD (30%) than ITB (10%) but did not reach statistical significance
(p=0.1).
Conclusions: A combined evaluation of clinical features, endoscopy, histology and response to treatment is the key to differentiate between CD and ITB.
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Keywords
Crohn’s disease, intestinal tuberculosis, differentiating, endoscopy, histology, serology
Citation
Dutta Amit Kumar, Sahu Manoj Kumar, Gangadharan Sajith Kattiparambil, Chacko Ashok. Distinguishing Crohn’s disease from intestinal tuberculosis – a prospective study. Tropical Gastroenterology. 2011 July-Sept; 32(3): 204-209.