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Gastrointestinal Tuberculosis HELP
Based on 492 articles published since 2010

These are the 492 published articles about Tuberculosis, Gastrointestinal that originated from Worldwide during 2010-2020.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19 · 20
1 Editorial Distinguishing between Crohn's disease, tuberculosis, and lymphoma: still in murky waters. 2014

Almadi, Majid A. ·Department of Medicine, Gastroenterology Division, King Khalid University Hospital, King Saud University, PO Box 2925, Riyadh 11461, Saudi Arabia. ·Saudi J Gastroenterol · Pubmed #25038204.

ABSTRACT: -- No abstract --

2 Editorial Learning from the genetics of enteric tuberculosis. 2011

Fox, Gregory J / Britton, Warwick J. · ·J Gastroenterol Hepatol · Pubmed #21672018.

ABSTRACT: -- No abstract --

3 Review [Challenges in diagnostics for intestinal tuberculosis - Pitfalls of a forgotten infectious disease: case series and literature review]. 2019

Ammer-Herrmenau, Christoph / Henrici, Patrick / Eiffert, Helmut / Amanzada, Ahmad / Mechie, Nicolae-Catalin / Bremmer, Felix / Seif Amir Hosseini, Ali / Ellenrieder, Volker / Wedi, Edris. ·Klinik für Gastroenterologie und gastrointestinale Onkologie der Universitätsmedizin Göttingen. · Institut für medizinische Mikrobiologie der Universitätsmedizin Göttingen. · Institut für Pathologie der Universitätsmedizin Göttingen. · Institut für Diagnostische und Interventionelle Radiologie der Universitätsmedizin Göttingen. ·Z Gastroenterol · Pubmed #31525799.

ABSTRACT: Intestinal tuberculosis is an infectious disease of the extrapulmonary manifestation with the Mycobacteria tuberculosis complex. In developed countries, this disease is rarely seen. The clinical features are heterogeneous and unspecific. Furthermore, intestinal tuberculosis poses diagnostic challenges. Regarding intestinal tuberculosis the Ziehl-Neelsen staining for acid-fast bacillus, PCR examination and culture methods show only poor sensitivity and specificity. In this case series, we present three patients suffering from intestinal tuberculosis, who were diagnosed and treated successfully. Furthermore, we review the literature about the pitfalls of the diagnostic approaches and the treatment options of intestinal tuberculosis.

4 Review Diagnosis of abdominal tuberculosis: lessons learned over 30 years: pectoral assay. 2019

Abu-Zidan, Fikri M / Sheek-Hussein, Mohamud. ·1Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, 17666 United Arab Emirates. · 2Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain, 17666 United Arab Emirates. ·World J Emerg Surg · Pubmed #31338118.

ABSTRACT: Diagnosing abdominal tuberculosis remains a great challenge even for experienced clinicians. It is a great mimicker that has unusual presentations. A high index of suspicion is essential for reaching its diagnosis. Clinical and radiological findings of abdominal tuberculosis are non-specific. Herein, we report the lessons we have learned over the last 30 years stemming from our own mistakes in diagnosing abdominal tuberculosis supported by illustrative challenging clinical cases. Furthermore, we report our diagnostic algorithm for abdominal tuberculosis. This diagnostic algorithm will help in reaching the proper diagnosis by histopathology or microbiology. Our diagnostic workup depends on categorizing the clinical and radiological findings of abdominal tuberculosis into five different categories including (1) gastrointestinal, (2) solid organ lesions, (3) lymphadenopathy, (4) wet peritonitis, and (5) dry/fixed peritonitis. The diagnosis in gastrointestinal tuberculosis and dry peritonitis can be reached by endoscopy. The diagnosis in solid organ lesions can be reached by ultrasound-guided aspiration. The diagnosis in wet peritonitis and lymphadenopathy can be reached by ultrasound-guided aspiration followed by laparoscopy if needed. Diagnostic laparotomy should be kept as the last option for achieving a histological diagnosis. Capsule endoscopy and enteroscopy were not included in the diagnostic algorithm because of the limited data of using these modalities in abdominal tuberculosis. They need special expertise, and rarely used in low- and middle-income countries. Furthermore, capsule endoscopy may cause complete intestinal obstruction in small bowel strictures. A definite diagnosis can be reached in only 80% of the patients. Therapeutic diagnosis should be tried in the remaining 20%.

5 Review [Treatment of abdominal tuberculosis : Background, diagnostics and treatment of a global problem]. 2019

Fahlbusch, T / Braumann, C / Uhl, W. ·Klinik für Allgemein- und Viszeralchirurgie, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland. t.fahlbusch@klinikum-bochum.de. · Klinik für Allgemein- und Viszeralchirurgie, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland. ·Chirurg · Pubmed #31321450.

ABSTRACT: BACKGROUND: Tuberculosis (TB) is among the 10 leading causes of global deaths and is a special threat to immunocompromised patients with human immunodeficiency virus (HIV). Due to migration from endemic areas cases in central Europe can also increase. OBJECTIVE: This article gives an overview of background information, detection methods, treatment and the role of surgery in abdominal manifestation of a systemic infection. MATERIAL AND METHODS: A PubMed search was carried out using the following keywords: abdominal TB, incidence, symptoms, diagnostics, treatment and surgery. RESULTS: The detection of TB in cases of abdominal manifestation can be carried out via percutaneous biopsy; however, laparoscopy is recommended due to the better detection rate, low complication rate and its ability to differentiate other diseases, such as peritoneal carcinomatosis and lymphomas. Antituberculous drugs are the primary treatment. An acute abdomen can occur in up to approximately 30% of cases. Complications such as strictures and perforations require surgical treatment. CONCLUSION: Although the prevalence of TB is decreasing, the infection causes more than 1 million deaths per year. The correct diagnosis can be impeded by a misleading clinical presentation. A multidisciplinary approach enables rapid and efficient diagnostics and treatment.

6 Review [Intestinal tuberculosis revealed by acute bowel obstruction during paradoxical reaction to antituberculosis treatment in an immunocompetent patient: about a case and literature review]. 2019

Shinga, Bruce Wembulua / Dièye, Alassane / Badiane, Ndèye Méry Dia / Lakhe, Ndèye Aissatou / Diallo, Viviane Marie-Pierre Cisse / Mbaye, Khadiatou Diallo / Ka, Daye / Badiane, Aboubakar Sidikh / Diouf, Assane / Déguénonvo, Louise Fortes / Ndour, Cheikh Tidiane / Seydi, Moussa. ·Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Sénégal. · UFR Santé, Université Gaston Berger, Saint-Louis, Sénégal. ·Pan Afr Med J · Pubmed #31303942.

ABSTRACT: Abdominal tuberculosis accounts for 3 to 5% of all visceral diseases. Despite the demonstrated effectiveness of anti-tuberculosis treatments, some cases of exacerbation of the initial clinical presentation have been described during the initiation of treatment. However, these reactions also known as "paradoxical" have been rarely reported in immunocompetent patients and much less in the case of bowel obstruction. We report a case of intestinal tuberculosis revealed by acute bowel obstruction during paradoxical reaction to anti-tuberculosis treatment. The study included a 26-year old immunocompetent patient with occlusive syndrome after a month of treatment for pleuropulmonary tuberculosis. Abdominal computed tomography (CT) showed small bowel obstruction. Laparotomy objectified intraperitoneal mass with multiple adhesions. Anatomo-pathological examination of the surgical specimen showed intestinal tuberculosis. Patient's outcome was favorable after the continuation of initial antituberculosis treatment.

7 Review Critical role of molecular test in early diagnosis of gastric tuberculosis: a rare case report and review of literature. 2019

Ma, Jun / Yin, Hongyun / Xie, Huikang. ·Clinic and Research Center of Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China. · Department of Tuberculosis and Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital Affiliated to Tongji University, 507 Zhengmin Road, Shanghai, 200433, China. · Clinic and Research Center of Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China. yinhongyun2004@163.com. · Pathology department, Shanghai Pulmonary Hospital Affiliated to Tongji University, 507 Zhengmin Road, Shanghai, 200433, China. ·BMC Infect Dis · Pubmed #31277586.

ABSTRACT: BACKGROUD: Early diagnosis of gastric tuberculosis is often challenging because the disease is very rare and its clinical manifestation is nonspecific and misleading. To raise the awareness and emphasize early diagnosis of gastric tuberculosis, we present a case of gastric tuberculosis secondary to pleural and pulmonary tuberculosis. CASE PRESENTATION: A 26-year-old woman complained gastric pain for 1 month but showed no other symptoms, who had no previous exposure to tuberculosis.Gastric stromal tumor was originally suspected. However, the pathology of her gastroscopic biopsy of the gastric lesion showed granulomatous lesions and caseating necrosis. Gene sequencing of the biopsy specimen identified deoxyribonucleic acid fragment of Mycobacterium tuberculosis. Chest computed tomography scan revealed nodular shadows in the lesser curvature soft tissue of the stomach, patchy densities and calcified nodular shadows in the upper right lung, bilateral pleural thickening, and calcified pleural nodules. Thus, the diagnosis was gastric tuberculosis secondary to pulmonary and pleural tuberculosis. The patient was hospitalized and treated with the antituberculosis therapy for 1 week. After discharged from the hospital, the patient continued routine antituberculosis therapy for 18 months and was follow-up was normal.Literature search found 22 cases of gastric tuberculosis reported from 2000 to 2016. Review of the 22 cases suggested that polymerase chain reaction has been increasingly used in the recent years in addition to the conventional histopathological and bacteriological approaches. CONCLUSION: Clinical presentation of gastric tuberculosis is not specific.When granuloma or caseation is detected on biopsy in patients who are suspected of having gastric malignancy or acid peptic diseases, polymerase chain reaction for Mycobacterium tuberculosis could be used as an available and sensitive diagnostic test in addition to pathology, acid-fast bacilli smear staining and culture.

8 Review Common and uncommon imaging features of abdominal tuberculosis. 2019

Gupta, Pankaj / Kumar, Suresh / Sharma, Vishal / Mandavdhare, Harshal / Dhaka, Narender / Sinha, Saroj K / Dutta, Usha / Kochhar, Rakesh. ·Department of Gastroenterology and Radiodiagnosis and Imaging, Postgraduate Institute of Medical Imaging and Research (PGIMER), Chandigarh, India. ·J Med Imaging Radiat Oncol · Pubmed #30932343.

ABSTRACT: Despite the advances in the medical care, tuberculosis (TB) still remains an important health problem. This is particularly relevant to the developing countries as well as the immunocompromised population in the developed world. Multidrug resistance poses another challenge and may be responsible for increasing incidence of TB, to some extent. The respiratory system is the most commonly involved, although any organ system may be affected. Abdominal involvement occurs in 11-12% of the patients with extrapulmonary TB. The clinical features of abdominal TB are nonspecific. Imaging plays an important role in the diagnosis of abdominal TB. Although a few imaging features strongly favour the possibility of TB, abdominal TB is a greater masquerader. In this review, we highlight the entire spectrum of the manifestations of abdominal tuberculosis (excluding the genitourinary involvement) with an emphasis on imaging findings.

9 Review Differentiating Crohn's disease from intestinal tuberculosis. 2019

Kedia, Saurabh / Das, Prasenjit / Madhusudhan, Kumble Seetharama / Dattagupta, Siddhartha / Sharma, Raju / Sahni, Peush / Makharia, Govind / Ahuja, Vineet. ·Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India. dr.saurabhkedia@aiims.edu. · Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India. · Department of Radiology, All India Institute of Medical Sciences, New Delhi 110029, India. · Department of GI Surgery, All India Institute of Medical Sciences, New Delhi 110029, India. · Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India. ·World J Gastroenterol · Pubmed #30700939.

ABSTRACT: Differentiating Crohn's disease (CD) and intestinal tuberculosis (ITB) has remained a dilemma for most of the clinicians in the developing world, which are endemic for ITB, and where the disease burden of inflammatory bowel disease is on the rise. Although, there are certain clinical (diarrhea/hematochezia/perianal disease common in CD; fever/night sweats common in ITB), endoscopic (longitudinal/aphthous ulcers common in CD; transverse ulcers/patulous ileocaecal valve common in ITB), histologic (caseating/confluent/large granuloma common in ITB; microgranuloma common in CD), microbiologic (positive stain/culture for acid fast-bacillus in ITB), radiologic (long segment involvement/comb sign/skip lesions common in CD; necrotic lymph node/contiguous ileocaecal involvement common in ITB), and serologic differences between CD and ITB, the only exclusive features are caseation necrosis on biopsy, positive smear for acid-fast bacillus (AFB) and/or AFB culture, and necrotic lymph node on cross-sectional imaging in ITB. However, these exclusive features are limited by poor sensitivity, and this has led to the development of multiple multi-parametric predictive models. These models are also limited by complex formulae, small sample size and lack of validation across other populations. Several new parameters have come up including the latest Bayesian meta-analysis, enumeration of peripheral blood T-regulatory cells, and updated computed tomography based predictive score. However, therapeutic anti-tubercular therapy (ATT) trial, and subsequent clinical and endoscopic response to ATT is still required in a significant proportion of patients to establish the diagnosis. Therapeutic ATT trial is associated with a delay in the diagnosis of CD, and there is a need for better modalities for improved differentiation and reduction in the need for ATT trial.

10 Review [Pancreatic tuberculosis]. 2018

Krylov, N N / Pyatenko, E A / Alekberzade, A V / Kupriyanov, I E. ·Sechenov First Moscow State Medical University, Moscow, Russia, Moscow, Russia. · Department of human anatomy of Sechenov First Moscow State Medical University, Moscow, Russia. ·Khirurgiia (Mosk) · Pubmed #30560858.

ABSTRACT: Prevalence, risk factors of primary pancreatic tuberculosis, clinical symptoms and data of instrumental and laboratory diagnosis are reviewed in the article. The authors emphasized the peculiarities of differential diagnosis with pancreatic malignancies and advisability of the most informative methods - endoscopy and fine-needle aspiration procedure.

11 Review Intestinal tuberculosis and Crohn's disease: the importance and difficulty of a differential diagnosis. 2018

Merino Gallego, Esther / Gallardo Sánchez, Francisco / Gallego Rojo, Francisco Javier. ·Aparato Digestivo, Hospital de Poniente, España. · AIG Digestivo, Hospital de Poniente. · Digestivo, Hospital de Poniente. ·Rev Esp Enferm Dig · Pubmed #30168341.

ABSTRACT: Tuberculosis (TB) is the most prevalent infection worldwide and affects one third of the population, predominantly in developing countries. Intestinal TB (ITB) is the sixth most frequent extra-pulmonary TB infection. Crohn's disease (CD) is a chronic inflammatory bowel disease that arises from the interaction of immunological, environmental and genetic factors. Due to changes in the epidemiology of both diseases, distinguishing CD from ITB is a challenge, particularly in immunocompromised patients and those from areas where TB is endemic. Furthermore, both TB and CD have a predilection for the ileocecal area. In addition, they share very similar clinical, radiological and endoscopic findings. An incorrect diagnosis and treatment may increase morbidity and mortality. Thus, a great degree of caution is required as well as a familiarity with certain characteristics of the diseases, which will aid the differentiation between the two diseases.

12 Review Differential diagnosis of inflammatory bowel disease: imitations and complications. 2018

Gecse, Krisztina B / Vermeire, Severine. ·Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, Netherlands. · Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium. Electronic address: severine.vermeire@uzleuven.be. ·Lancet Gastroenterol Hepatol · Pubmed #30102183.

ABSTRACT: Inflammatory bowel disease (IBD) is characterised by episodes of relapse and periods of remission. However, the clinical features, such as abdominal pain, diarrhoea, and rectal bleeding, are not specific. Therefore, the differential diagnosis can include a broad spectrum of inflammatory or infectious diseases that mimic IBD, as well as others that might complicate existing IBD. In this Review, we provide an overview of ileocolitis of diverse causes that are relevant in the differential diagnosis of IBD. We highlight the importance of accurate patient profiling and give a practical approach to identifying factors that should trigger the search for a specific cause of intestinal inflammation. Mimics of IBD include not only infectious causes of colitis-and particular attention is required for patients from endemic areas of tuberculosis-but also vascular diseases, diversion colitis, diverticula or radiation-related injuries, drug-induced inflammation, and monogenic diseases in very-early-onset refractory disease. A superinfection with cytomegalovirus or Clostridium difficile can aggravate intestinal inflammation in IBD, especially in patients who are immunocompromised. Special consideration should be made to the differential diagnosis of perianal disease.

13 Review Radiological Diagnoses in the Context of Emigration: Infectious diseases. 2018

Stojkovic, Marija / Müller, Jan / Junghanss, Thomas / Weber, Tim Frederik. ·Department of Clinical Tropical Medicine, University Hospital Heidelberg, Germany. · Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany. ·Rofo · Pubmed #29100256.

ABSTRACT: BACKGROUND: Globalization and emigration impact on the spectrum of diseases challenging health care systems. Medical practitioners have to particularly prepare for infectious diseases. METHODS: The database of a health care center specialized on tropical medicine was screened for patients with history of migration and one of the following diagnoses: Cystic echinococcosis, tuberculosis, schistosomiasis, visceral leishmaniosis, and neurocysticercosis. Representative casuistics were prepared from select case histories. Radiological pertinent knowledge was compiled based on literature search. RESULTS: A small selection of frequently imported infectious diseases covers a considerable fraction of health care problems associated with migration. For cystic echinococcosis, schistosomiasis, and neurocysticercosis imaging is the most relevant diagnostic procedure defining also disease stages. Tuberculosis and visceral leishmaniosis are important differentials for malignant diseases. CONCLUSION: Imaging plays a meaningful role in diagnosis, treatment stratification, and follow-up of imported infectious diseases. Radiological skills concerning these diseases are important for providing health care for patients in context of migration. KEY POINTS: · Imaging plays a meaningful role in multidisciplinary care for imported infectious diseases.. · A small selection covers a considerable fraction of infectious diseases expected in context of migration.. CITATION FORMAT: · Stojkovic M, Müller J, Junghanss T et al. Radiological Diagnoses in the Context of Emigration: Infectious diseases. Fortschr Röntgenstr 2018; 190: 121 - 133.

14 Review Extrapulmonary involvement in pediatric tuberculosis. 2017

Kritsaneepaiboon, Supika / Andres, Mariaem M / Tatco, Vincent R / Lim, Cielo Consuelo Q / Concepcion, Nathan David P. ·Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90110, Thailand. supikak@yahoo.com. · Institute of Radiology, St. Luke's Medical Center, 32nd Avenue corner 5th Street, Bonifacio Global City, 1634, Taguig City, Philippines. · Institute of Radiology, St. Luke's Medical Center, 279 E. Rodriquez Sr. Boulevard, 1102, Quezon City, Philippines. ·Pediatr Radiol · Pubmed #29052770.

ABSTRACT: Tuberculosis in childhood is clinically challenging, but it is a preventable and treatable disease. Risk factors depend on age and immunity status. The most common form of pediatric tuberculosis is pulmonary disease, which comprises more than half of the cases. Other forms make up the extrapulmonary tuberculosis that involves infection of the lymph nodes, central nervous system, gastrointestinal system, hepatobiliary tree, and renal and musculoskeletal systems. Knowledge of the imaging characteristics of pediatric tuberculosis provides clues to diagnosis. This article aims to review the imaging characteristics of common sites for extrapulmonary tuberculous involvement in children.

15 Review Tubercular Abdominal Cocoon: Systematic Review of an Uncommon Form of Tuberculosis. 2017

Sharma, Vishal / Singh, Harjeet / Mandavdhare, Harshal S. ·Department of Gastroenterology and General Surgery, Postgraduate Institute of Medical Education and Research , India . ·Surg Infect (Larchmt) · Pubmed #28759335.

ABSTRACT: BACKGROUND: Abdominal cocoon formation is an uncommon manifestation of abdominal tuberculosis that is characterized by the formation of a fibrous membrane-like sac around the small intestinal loops. Appropriate treatment and outcomes are uncertain Objectives: To review the clinical presentation, treatment, and outcomes for tubercular abdominal cocoon (TAC). PATIENTS AND METHODS: We included studies published in the English language and listed in EMBASE or PubMed. All case series or reports that reported patients with TAC were considered for inclusion. Details regarding demographic, clinical presentation, and treatment received were tabulated. RESULTS: The clinical features included predominantly abdominal pain, abdominal distension and features of intestinal obstruction, loss of appetite, and weight loss. The diagnosis was usually established at surgery, however, computed tomography was a useful tool. In most patients the treatment reported was surgical, however, conservative therapy with anti-tubercular therapy (ATT) did succeed in a subset of patients. The published literature includes only case series and reports. The outcomes, especially long-term outcomes, have not been reported in most studies. CONCLUSION: Abdominal cocoon is an uncommon form of abdominal tuberculosis and conservative management with ATT may suffice in some patients whereas non-responsive cases require surgery.

16 Review Mass-forming lesions of the duodenum: A pictorial review. 2017

Barat, M / Dohan, A / Dautry, R / Barral, M / Boudiaf, M / Hoeffel, C / Soyer, P. ·Department of Radiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France. Electronic address: maxime.barat89@gmail.com. · Department of Radiology, McGill University Health Centre, Montreal General and Royal Victoria Hospitals, Montreal, Canada. Electronic address: anthony.dohan@aphp.fr. · Department of Radiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France. Electronic address: raphael.dautry@aphp.fr. · Department of Radiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France. Electronic address: matthiasbarral@gmail.com. · Pôle santé du plateau, 3/5, avenue de Villacoublay, 92360 Meudon-La-Forêt, France. Electronic address: mourad.boudiaf@aphp.fr. · Department of Radiology, hôpital Robert-Debré, 11, boulevard Pasteur, 51092 Reims, France. Electronic address: choeffel-fornes@chu-reims.fr. · Medicine department, Université Paris-Diderot, Sorbonne Paris Cité, 10, avenue de Verdun, 75010 Paris, France. Electronic address: philippe.soyer@aphp.fr. ·Diagn Interv Imaging · Pubmed #28185840.

ABSTRACT: Recent advances in imaging have resulted in marked changes in the investigation of the duodenum, which still remains primarily evaluated with videoendoscopy. However, improvements in computed tomography (CT) and magnetic resonance (MR) imaging have made detection and characterization of duodenal mass-forming abnormalities easier. The goal of this pictorial review was to illustrate the most common conditions of the duodenum that present as mass-forming lesions with a specific emphasis on CT and MR imaging. MR imaging used in conjunction with duodenal distension appears as a second line imaging modality for the characterization of duodenal mass-forming lesions. CT remains the first line imaging modality for the detection and characterization of a wide range of duodenal mass-forming lesions.

17 Review The diagnostic value of polymerase chain reaction for 2017

Jin, Ting / Fei, Baoying / Zhang, Yu / He, Xujun. ·The First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang, China. · Department of Gastroenterology, Tongde, Hospital of Zhejiang Province, Zhejiang, China. · First School of Clinical Medicine Wenzhou Medical University, Wenzhou, Zhejiang, China. · Department of Gastroenterological Laboratory, Zhejiang Province People's Hospital, Zhejiang, China. ·Saudi J Gastroenterol · Pubmed #28139494.

ABSTRACT: BACKGROUND/AIM: Intestinal tuberculosis (ITB) and Crohn's disease (CD) are important differential diagnoses that can be difficult to distinguish. Polymerase chain reaction (PCR) for Mycobacterium tuberculosis (MTB) is an efficient and promising tool. This meta-analysis was performed to systematically and objectively assess the potential diagnostic accuracy and clinical value of PCR for MTB in distinguishing ITB from CD. MATERIALS AND METHODS: We searched PubMed, Embase, Web of Science, Science Direct, and the Cochrane Library for eligible studies, and nine articles with 12 groups of data were identified. The included studies were subjected to quality assessment using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. RESULTS: The summary estimates were as follows: sensitivity 0.47 (95% CI: 0.42-0.51); specificity 0.95 (95% CI: 0.93-0.97); the positive likelihood ratio (PLR) 10.68 (95% CI: 6.98-16.35); the negative likelihood ratio (NLR) 0.49 (95% CI: 0.33-0.71); and diagnostic odds ratio (DOR) 21.92 (95% CI: 13.17-36.48). The area under the curve (AUC) was 0.9311, with a Q* value of 0.8664. Heterogeneity was found in the NLR. The heterogeneity of the studies was evaluated by meta-regression analysis and subgroup analysis. CONCLUSIONS: The current evidence suggests that PCR for MTB is a promising and highly specific diagnostic method to distinguish ITB from CD. However, physicians should also keep in mind that negative results cannot exclude ITB for its low sensitivity. Additional prospective studies are needed to further evaluate the diagnostic accuracy of PCR.

18 Review Meta-Analytic Bayesian Model For Differentiating Intestinal Tuberculosis from Crohn's Disease. 2017

Limsrivilai, Julajak / Shreiner, Andrew B / Pongpaibul, Ananya / Laohapand, Charlie / Boonanuwat, Rewat / Pausawasdi, Nonthalee / Pongprasobchai, Supot / Manatsathit, Sathaporn / Higgins, Peter D R. ·Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA. · Division of Gastroenterology, Siriraj Hospital, Mahidol University, Bangkok, Thailand. · Department of Pathology, Siriraj Hospital, Mahidol University, Bangkok, Thailand. ·Am J Gastroenterol · Pubmed #28045023.

ABSTRACT: OBJECTIVES: Distinguishing intestinal tuberculosis (ITB) from Crohn's disease (CD) is difficult, although studies have reported clinical, endoscopic, imaging, and laboratory findings that help to differentiate these two diseases. We aimed to produce estimates of the predictive power of these findings and construct a comprehensive model to predict the probability of ITB vs. CD. METHODS: A systematic literature search for studies differentiating ITB from CD was conducted in MEDLINE, PUBMED, and EMBASE from inception until September 2015. Fifty-five distinct meta-analyses were performed to estimate the odds ratio of each predictive finding. Estimates with a significant difference between CD and ITB and low to moderate heterogeneity (I RESULTS: Thirty-eight studies comprising 2,117 CD and 1,589 ITB patients were included in the analyses. Findings in the model that significantly favored CD included male gender, hematochezia, perianal disease, intestinal obstruction, and extraintestinal manifestations; endoscopic findings of longitudinal ulcers, cobblestone appearance, luminal stricture, mucosal bridge, and rectal involvement; pathological findings of focally enhanced colitis; and computed tomographic enterography (CTE) findings of asymmetrical wall thickening, intestinal wall stratification, comb sign, and fibrofatty proliferation. Findings that significantly favored ITB included fever, night sweats, lung involvement, and ascites; endoscopic findings of transverse ulcers, patulous ileocecal valve, and cecal involvement; pathological findings of confluent or submucosal granulomas, lymphocyte cuffing, and ulcers lined by histiocytes; a CTE finding of short segmental involvement; and a positive interferon-γ release assay. The model was validated by gender, clinical manifestations, endoscopic, and pathological findings in 49 patients (27 CD, 22 ITB). The sensitivity, specificity, and accuracy for diagnosis of ITB were 90.9%, 92.6%, and 91.8%, respectively. CONCLUSIONS: A Bayesian model based on the meta-analytic results is presented to estimate the probability of ITB and CD calibrated to local prevalence. This model can be applied to patients using a publicly available web application.

19 Review Gastrointestinal Tuberculosis. 2016

Choi, Eric H / Coyle, Walter J. ·University of California Riverside School of Medicine and Riverside Medical Clinic, Riverside, CA 92506. · Scripps Clinic Torrey Pines, LaJolla, CA 92037. ·Microbiol Spectr · Pubmed #28084201.

ABSTRACT: Gastrointestinal tuberculosis (TB) is a fascinating disease which can be observed both in the clinical context of active pulmonary disease and as a primary infection with no pulmonary involvement. It represents a significant clinical challenge because of the resurgence of TB as well as the diagnostic challenges it poses. A high clinical suspicion remains the most powerful tool in an era of medicine when reliance on diagnostic technology increases. Antimicrobial therapy is the mainstay of therapy, but surgical and endoscopic interventions are frequently required for intestinal TB. Gastrointestinal TB is truly the "great mimic" and continues to require the astute clinical acumen of skillful clinicians to diagnose and treat.

20 Review Six-month therapy for abdominal tuberculosis. 2016

Jullien, Sophie / Jain, Siddharth / Ryan, Hannah / Ahuja, Vineet. ·Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK. ·Cochrane Database Syst Rev · Pubmed #27801499.

ABSTRACT: BACKGROUND: Tuberculosis (TB) of the gastrointestinal tract and any other organ within the abdominal cavity is abdominal TB, and most guidelines recommend the same six-month regimen used for pulmonary TB for people with this diagnosis. However, some physicians are concerned whether a six-month treatment regimen is long enough to prevent relapse of the disease, particularly in people with gastrointestinal TB, which may sometimes cause antituberculous drugs to be poorly absorbed. On the other hand, longer regimens are associated with poor adherence, which could increase relapse, contribute to drug resistance developing, and increase costs to patients and health providers. OBJECTIVES: To compare six-month versus longer drug regimens to treat people that have abdominal TB. SEARCH METHODS: We searched the following electronic databases up to 2 September 2016: the Cochrane Infectious Diseases Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase (accessed via OvidSP), LILACS, INDMED, and the South Asian Database of Controlled Clinical Trials. We searched the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov for ongoing trials. We also checked article reference lists. SELECTION CRITERIA: We included randomized controlled trials (RCTs) that compared six-month regimens versus longer regimens that consisted of isoniazid, rifampicin, pyrazinamide, and ethambutol to treat adults and children that had abdominal TB. The primary outcomes were relapse, with a minimum of six-month follow-up after completion of antituberculous treatment (ATT), and clinical cure at the end of ATT. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, extracted data, and assessed the risk of bias in the included trials. For analysis of dichotomous outcomes, we used risk ratios (RR) with 95% confidence intervals (CIs). Where appropriate, we pooled data from the included trials in meta-analyses. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: We included three RCTs, with 328 participants, that compared six-month regimens with nine-month regimens to treat adults with intestinal and peritoneal TB. All trials were conducted in Asia, and excluded people with HIV, those with co-morbidities and those who had received ATT in the previous five years. Antituberculous regimens were based on isoniazid, rifampicin, pyrazinamide, and ethambutol, and these drugs were administered daily or thrice weekly under a directly observed therapy programme. The median duration of follow-up after completion of treatment was between 12 and 39 months.Relapse was uncommon, with two cases among 140 participants treated for six months, and no events among 129 participants treated for nine months. The small number of participants means we do not know whether or not there is a difference in risk of relapse between the two regimens (very low quality evidence). At the end of therapy, there was probably no difference in the proportion of participants that achieved clinical cure between six-month and nine-month regimens (RR 1.02, 95% CI 0.97 to 1.08; 294 participants, 3 trials, moderate quality evidence). For death, there were 2/150 (1.3%) in the six-month group and 4/144 (2.8%) in the nine-month group. All deaths occurred in the first four months of treatment, so was not linked to the duration of treatment in the included trials. Similarly, the number of participants that defaulted from treatment was small in both groups, and there may be no difference between them (RR 0.50, 95% CI 0.10 to 2.59; 294 participants, 3 trials, low quality evidence). Only one trial reported on adherence to treatment, with only one participant allocated to the nine-month regimen presenting poor adherence to treatment. We do not know whether six-month regimens are associated with fewer people experiencing adverse events that lead to treatment interruption (RR 0.53, 95% CI 0.18 to 1.55; 318 participants, 3 trials, very low quality evidence). AUTHORS' CONCLUSIONS: We found no evidence to suggest that six-month treatment regimens are inadequate for treating people that have intestinal and peritoneal TB, but numbers are small. We did not find any incremental benefits of nine-month regimens regarding relapse at the end of follow-up, or clinical cure at the end of therapy, but our confidence in the relapse estimate is very low because of size of the trials. Further research is required to make confident conclusions regarding the safety of six-month treatment for people with abdominal TB. Larger studies that include HIV-positive people, with long follow-up for detecting relapse with reliability, would help improve our knowledge around this therapeutic question.

21 Review Abdominal Tuberculosis. 2016

Rathi, Pravin / Gambhire, Pravir. ·Prof. and Head of Department. · Senior Resident, Gastroenterology Department, Topiwala National Medical College and B.Y.L. Nair Hospital, Mumbai, Maharashtra. ·J Assoc Physicians India · Pubmed #27730779.

ABSTRACT: Abdomen is involved in 11% of patients with extra-pulmonary tuberculosis; The most common site of involvement is the ileocaecal region, other locations of involvement, in order of descending frequency, are the ascending colon, jejunum, appendix, duodenum, stomach, oesophagus, sigmoid colon, and rectum. Apart from the basic work up, Investigations like CT scan, EUS, Capsule endoscopy, Balloon enteroscopy, Ascitic fluid ADA, TB-PCR, GeneXpert, Laproscopy are being increasingly used to diagnose tuberculosis.Therapy with standard antituberculous drugs is usually highly effective for intestinal TB. Six-months therapy is as effective as nine-months therapy. Multi-Drug Resistance (MDR) has been observed in 13% of MTB isolates. The development of Drug Induced Hepatotoxicity (DIH) during therapy for TB is the most common reason leading to interruption of therapy. There are various guidelines for the management of TB post DIH. Surgery is usually reserved for patients who have developed complications or obstruction not responding to medical management.

22 Review Intestinal tuberculosis and Crohn's disease: challenging differential diagnosis. 2016

Ma, Jia Yi / Tong, Jin Lu / Ran, Zhi Hua. ·Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai Inflammatory Bowel Disease Research Center, Shanghai, China. ·J Dig Dis · Pubmed #26854750.

ABSTRACT: Along with epidemiological changes in tuberculosis (TB) and an increased incidence of Crohn's disease (CD), the differential diagnosis of intestinal TB (ITB) and CD is of vital importance and has become a clinical challenge because treatment based on misdiagnosis may lead to fatal outcomes. In this study, we reviewed the similarities and differences in clinical, endoscopic, radiological and histological features of these two diseases. Concomitant pulmonary TB, ascites, night sweats, involvement of fewer than four segments of the bowel, patulous ileocecal valve, transverse ulcers, scars or pseudopolyps strongly indicate ITB. Bloody stools, perianal signs, chronic diarrhea, extraintestinal manifestations, anorectal lesions, longitudinal ulcers and a cobblestone appearance are all suggestive of CD. Significant differences in the size, number, location and patterns of granulomas in ITB and CD with regard to their histopathologic features have been noted. Immune stain of cell surface markers is also helpful. Interferon-γ release assay and polymerase chain reaction analysis have achieved satisfactory sensitivity and specificity in the diagnosis of ITB. Computed tomography enterographic findings of segmental small bowel or left colon involvement, mural stratification, the comb sign and fibrofatty proliferation are significantly more common in CD, whereas mesenteric lymph node changes (calcification or central necrosis) and focal ileocecal lesions are more frequently seen in ITB. A diagnosis should be carefully established before the initiation of the therapy. In suspicious cases, short-term empirical anti-TB therapy is quite efficient to further confirm the diagnosis.

23 Review Paediatric abdominal tuberculosis in developed countries: case series and literature review. 2016

Delisle, Megan / Seguin, Jade / Zeilinski, David / Moore, Dorothy L. ·McGill University, Montreal, Canada. · Department of Emergency Medicine, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada. · Division of Respiratory Medicine, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada. · Division of Infectious Diseases, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada. ·Arch Dis Child · Pubmed #26699532.

ABSTRACT: OBJECTIVE: To provide an insight into the presentation, diagnosis and management of paediatric abdominal tuberculosis (TB) in developed countries. METHODS: The records of all children at the Montreal Children's Hospital (MCH) admitted with abdominal TB between 1990 and 2014 were reviewed. An automated and manual literature search from 1946 to 2014 was performed. RESULTS: (1) CASE SERIES: six cases were identified at the MCH. All were male between 5 and 17 years of age. All were from populations known to have high rates of TB (aboriginal, immigrant). Three underwent major surgical interventions and three underwent ultrasound (US) or CT aspiration or biopsy for diagnosis. (2) LITERATURE REVIEW: 29 male (64%) and 16 female subjects (36%) aged between 14 months and 18 years were identified, including the MCH patients. All patients except one were from populations with a high incidence of TB. Most presented with a positive tuberculin skin test (90%), abdominal pain (76%), fever (71%) and weight loss (68%). On imaging, 22 (49%) were classified with gastrointestinal TB with colonic wall irregularity (41%) and 19 (42%) with peritoneal TB with ascites (68%). A positive culture was obtained in 33 (73%) patients. Three cases used CT- or US-guided aspiration or biopsy to obtain tissue samples. A surgical intervention was performed in 34 (76%) children; 13 (38%) of these were for diagnosis. CONCLUSIONS: Diagnosis based on clinical features (abdominal pain, fever and weight loss) and CT- or US-guided aspiration or biopsy may encourage physicians to adopt a more conservative approach to abdominal TB.

24 Review Childhood abdominal tuberculosis: Disease patterns, diagnosis, and drug resistance. 2015

Malik, Rohan / Srivastava, Anshu / Yachha, Surender K / Poddar, Ujjal / Lal, Richa. ·Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India. · Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India. skyachha@sgpgi.ac.in. · Department of Pediatric Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226 014, India. ·Indian J Gastroenterol · Pubmed #26678593.

ABSTRACT: OBJECTIVE: Childhood abdominal tuberculosis may be difficult to diagnose with certainty. Drug resistance adds to the challenge. We present our experience in children with this condition. METHODS: The case records of all children <18 years of age and diagnosed as abdominal tuberculosis from January 2000 to April 2012 were reviewed. The clinical details; investigative profile (imaging, ascitic fluid analysis, upper gastrointestinal (GI) endoscopy, colonoscopy, and laparotomy); histopathology; microbiology; and response to antitubercular therapy was noted. RESULTS: Thirty-eight children (median age 11, range 4-16 years) were diagnosed. Multiple intraabdominal sites were involved in 12 (32 %), peritoneal alone in 9 (24 %); isolated intestinal and isolated lymph nodal in 6 (16 %) each. Three children had atypical presentations with gastric outlet obstruction, acute lower GI bleeding, and duodenal perforation, respectively. Overall, definitive bacteriological diagnosis was possible in 47 % (18/38). In others, diagnosis was supported by histopathology (19 %) or other supportive investigations (34 %) along with a response to treatment without relapse. Drug-resistant disease was diagnosed in three (8 %, two multidrug resistant, one extended drug resistant) all of whom presented with a similar clinical picture of large abdominal lymph node masses. CONCLUSION: Abdominal tuberculosis is still a challenging diagnosis with microbiological confirmation possible only in half of the cases. Atypical presentations and emergence of drug resistance should be kept in mind while managing these patients.

25 Review The histopathological mimics of inflammatory bowel disease: a critical appraisal. 2015

Woodman, I / Schofield, J B / Haboubi, N. ·Department of Cellular Pathology, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK. Isabel.Woodman@nhs.net. · Department of Cellular Pathology, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK. · Department of Pathology, University Hospital of South Manchester, Manchester, UK. ·Tech Coloproctol · Pubmed #26385573.

ABSTRACT: The pathological diagnosis of inflammatory bowel disease (IBD) is often difficult because biopsy material may not contain pathognomonic features, making distinction between Crohn's disease, ulcerative colitis and other forms of colitides a truly challenging exercise. The problem is further complicated as several diseases frequently mimic the histological changes seen in IBD. Successful diagnosis is reliant on careful clinicopathological correlation and recognising potential pitfalls. This is best achieved in a multidisciplinary team setting when the full clinical history, endoscopic findings, radiology and relevant serology and microbiology are available. In this review, we present an up-to-date evaluation of the histopathological mimics of IBD.