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Gastrointestinal Tuberculosis: HELP
Articles by Prasenjit Das
Based on 10 articles published since 2010
(Why 10 articles?)
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Between 2010 and 2020, Prasenjit Das wrote the following 10 articles about Tuberculosis, Gastrointestinal.
 
+ Citations + Abstracts
1 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.

2 Article CD4+ CD25+ FOXP3+ T cell frequency in the peripheral blood is a biomarker that distinguishes intestinal tuberculosis from Crohn's disease. 2018

Tiwari, Veena / Kedia, Saurabh / Garg, Sushil Kumar / Rampal, Ritika / Mouli, V Pratap / Purwar, Anuja / Mitra, D K / Das, Prasenjit / Dattagupta, S / Makharia, Govind / Acharya, S K / Ahuja, Vineet. ·Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. · Department of HLA and Transplant Immunology, All India Institute of Medical Sciences, New Delhi, India. · Department of Pathology, All India Institute of Medical Sciences, New Delhi, India. ·PLoS One · Pubmed #29489879.

ABSTRACT: BACKGROUND: Distinguishing between Crohn's Disease (CD) and Intestinal Tuberculosis (ITB) has been a challenging task for clinicians due to their similar presentation. CD4+FOXP3+ T regulatory cells (Tregs) have been reported to be increased in patients with pulmonary tuberculosis. However, there is no such data available in ITB. The aim of this study was to investigate the differential expression of FOXP3+ T cells in patients with ITB and CD and its utility as a biomarker. METHODS: The study prospectively recruited 124 patients with CD, ITB and controls: ulcerative colitis (UC) and patients with only haemorrhoidal bleed. Frequency of CD4+CD25+FOXP3+ Tregs in peripheral blood (flow cytometry), FOXP3 mRNA expression in blood and colonic mucosa (qPCR) and FOXP3+ T cells in colonic mucosa (immunohistochemistry) were compared between controls, CD and ITB patients. RESULTS: Frequency of CD4+CD25+FOXP3+ Treg cells in peripheral blood was significantly increased in ITB as compared to CD. Similarly, significant increase in FOXP3+ T cells and FOXP3 mRNA expression was observed in colonic mucosa of ITB as compared to CD. ROC curve showed that a value of >32.5% for FOXP3+ cells in peripheral blood could differentiate between CD and ITB with a sensitivity of 75% and a specificity of 90.6%. CONCLUSION: Phenotypic enumeration of peripheral CD4+CD25+FOXP3+ Treg cells can be used as a non-invasive biomarker in clinics with a high diagnostic accuracy to differentiate between ITB and CD in regions where TB is endemic.

3 Article Combination of increased visceral fat and long segment involvement: Development and validation of an updated imaging marker for differentiating Crohn's disease from intestinal tuberculosis. 2018

Kedia, Saurabh / Madhusudhan, Kumble S / Sharma, Raju / Bopanna, Sawan / Yadav, Dawesh P / Goyal, Sandeep / Jain, Saransh / Das, Prasenjit / Dattagupta, Siddhartha / Makharia, Govind / Ahuja, Vineet. ·Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India. · Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India. · Department of Pathology, All India Institute of Medical Sciences, New Delhi, India. ·J Gastroenterol Hepatol · Pubmed #29205485.

ABSTRACT: BACKGROUND AND AIM: Computed tomographic (CT) features (long segment, ileocaecal area involvement, and lymph nodes > 1 cm) have demonstrated good specificity but poor sensitivity, while visceral to subcutaneous fat ratio on CT (VF/SC > 0.63) has moderate sensitivity and specificity in differentiating Crohn's disease (CD) and intestinal tuberculosis (ITB). This study aims to develop and validate an updated model incorporating CT features and VF/SC to improve the diagnostic accuracy of imaging in differentiating CD/ITB. METHODS: Computed tomographic features and VF/SC were documented in two cohorts (development [n = 59, follow-up: January 2012 to November 2014] and validation [n = 69, follow-up: December 2014 to December 2015]) of CD/ITB patients diagnosed by standard criteria. Patients with normal CT were excluded. Features significantly different between CD/ITB were incorporated into a model. RESULTS: In both the cohorts, necrotic lymph nodes were exclusive for ITB (23.1% vs 0% and 43.3% vs 0%), while long segment involvement (57.6% vs 7.7%, P < 0.001, and 52.6% vs 16.1%, P < 0.001) and VF/SC ratio > 0.63 (72.7% vs 19.2%, P < 0.001, and 81.6% vs 25.8%, P < 0.001) were significantly more common in CD. A risk score of 2, based upon long segment involvement and VF/SC ratio > 0.63, had an excellent specificity of 100% and 100% and sensitivity of 54% and 50% for CD in development and validation cohorts, respectively. Based upon these features, in 43% patients with the diagnostic dilemma of CD/ITB, a definite diagnosis based only on imaging could be made. CONCLUSION: Necrotic lymph nodes are exclusive for ITB, and the combination of long segment involvement and VF/SC ratio > 0.63 is exclusive for CD, and these features can make a definite diagnosis in 43% patients with a CD/ITB dilemma.

4 Article Tubercular Intestinal Strictures Show a Poor Response to Anti-Tuberculous Therapy. 2017

Aggarwal, Piyush / Kedia, Saurabh / Sharma, Raju / Bopanna, Sawan / Madhusudhan, Kumble Seetharama / Yadav, Dawesh P / Goyal, Sandeep / Jain, Saransh / Mouli, Venigalla Pratap / Das, Prasenjit / Dattagupta, Siddhartha / Makharia, Govind / Ahuja, Vineet. ·Department of Gastroenterology, All India Institute of Medical Sciences, Room No 3111, Third Floor, Teaching Block, New Delhi, 110070, India. · Department of Radiodiagnosis, All India Institute of Medical Sciences, Room No 66, New Delhi, 110070, India. · Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110070, India. · All India Institute of Medical Sciences, Room No 3065, Third Floor, Teaching Block, New Delhi, 110070, India. · Department of Gastroenterology, All India Institute of Medical Sciences, Room No 3093, Third Floor, Teaching Block, New Delhi, 110070, India. vins_ahuja@hotmail.com. ·Dig Dis Sci · Pubmed #28856488.

ABSTRACT: BACKGROUND: The literature on resolution of intestinal strictures in patients with intestinal tuberculosis (ITB) after anti-tuberculous therapy (ATT) is sparse and ambivalent. We aimed to assess the frequency of stricture resolution after ATT and its predictors. METHODS: This ambispective cohort study included consecutive ITB patients with strictures who received ATT for ≥6 months and were on regular follow-up between January 2004 and December 2015. Resolution of stricture was assessed at the end of ATT by endoscopy/radiology. RESULTS: Of 286 patients, 128 had strictures, and 106 were finally included (63 males, median age 35 years). The stricture location was distal ileum/ileocecal in 52 (49.1%), colon in 37 (34.9%), ileocolonic in 4 (3.8%), proximal small bowel in 10 (9.4%), and gastroduodenal in 4 (3.8%) patients. Although all patients demonstrated mucosal healing (indicating resolution of active infection), stricture resolution occurred only in 25/106 (23.6%) patients. Symptoms pertaining to stricture (pain abdomen/recurrent SAIO) were present in 104/106 (98%) patients, and after a median of 6 (6-9) months of ATT, these symptoms resolved only in half, 88% (22/25) in patients with stricture resolution and 38% (30/79) in patients with persistent strictures. Colonic strictures had the least resolution (5.4%) followed by proximal small intestinal (20%) and distal ileal/ileocecal (36.5%). Although not statistically significant, stricture resolution was less frequent in patients with multiple strictures, longer strictures (>3 cm), and strictures in which scope was not negotiable prior to ATT. CONCLUSION: 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.

5 Article Prevalence and Association of Mycobacterium avium subspecies paratuberculosis with Disease Course in Patients with Ulcero-Constrictive Ileocolonic Disease. 2016

Khan, Imteyaz Ahmad / Pilli, Sucharita / A, Surendranath / Rampal, Ritika / Chauhan, Sudhir Kumar / Tiwari, Veena / Mouli, Venigalla Pratap / Kedia, Saurabh / Nayak, Baibaswata / Das, Prasenjit / Makharia, Govind K / Ahuja, Vineet. ·Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. · Department of Pathology, All India Institute of Medical Sciences, New Delhi, India. ·PLoS One · Pubmed #27019109.

ABSTRACT: BACKGROUND: Association of Mycobacterium avium subspecies paratuberculosis (MAP) and Crohn's disease (CD) has been controversial due to contradictory reports. Therefore, we determined the prevalence of MAP in patients with CD and intestinal tuberculosis (ITB) and its association with clinical course. METHODOLOGY: Blood and intestinal biopsies were taken from 69 CD, 32 ITB patients and 41 patients with haemorrhoidal bleed who served as controls. qPCR targeting of MAP-specific IS900 gene was used to detect the presence of MAP DNA. qPCR results were further validated by sequencing. Immunohistochemistry (IHC) was used to detect the presence of MAP antigen in biopsy specimens. CD and ITB patients were followed-up for disease course and response to therapy. PRINCIPAL FINDINGS: The frequency of MAP-specific DNA in biopsies by qPCR was significantly higher in CD patients (23.2%, p = 0.03) as compared to controls (7.3%). No significant difference in intestinal MAP presence was observed between ITB patients (12.5%, p = 0.6) and controls (7.3%). MAP presence in blood of CD patients was 10.1% as compared to 4.9% in controls while no patients with ITB were found to be positive (p = 0.1). Using IHC for detection of MAP antigen, the prevalence of MAP in CD was 2.9%, 12.5% in ITB patients and 2.4% in controls. However, long-term follow-up of the patients revealed no significant associations between clinical characteristics and treatment outcomes with MAP positivity. CONCLUSION: We report significantly high prevalence of MAP in intestinal biopsies of CD patients. However, the presence of MAP does not affect the disease course and treatment outcomes in either CD or ITB patients.

6 Article Proteome analysis of the macroscopically affected colonic mucosa of Crohn's disease and intestinal tuberculosis. 2016

Rukmangadachar, Lokesh A / Makharia, Govind K / Mishra, Asha / Das, Prasenjit / Hariprasad, Gururao / Srinivasan, Alagiri / Gupta, Siddhartha Datta / Ahuja, Vineet / Acharya, Subrat K. ·Department of Biophysics, All India Institute of Medical Sciences, New Delhi, India. · Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. · Department of Pathology, All India Institute of Medical Sciences, New Delhi, India. ·Sci Rep · Pubmed #26988818.

ABSTRACT: Differentiation between intestinal tuberculosis (ITB) and Crohn's disease (CD) is challenging in geographical regions where both these diseases are prevalent. There is a need of biomarkers for differentiation between these two disorders. Colonic biopsies from inflamed mucosa of treatment-naive patients with ITB, CD and controls were used for analysis. Protein extracted from biopsies was digested with trypsin and resulting peptides were labeled with iTRAQ reagents. The peptides were subsequently analyzed using LC-MS/MS for identification and quantification. Gene ontology annotation for proteins was analyzed in PANTHER. Validation experiments were done for six differentially expressed proteins using immunohistochemistry. 533 proteins were identified and 241 proteins were quantified from 5 sets of iTRAQ experiments. While 63 were differentially expressed in colonic mucosa of patients with CD and ITB in at least one set of iTRAQ experiment, 11 proteins were differentially expressed in more than one set of experiments. Six proteins used for validation using immunohistochemistry in a larger cohort of patients; none of them however was differentially expressed in patients with ITB and CD. There are differentially expressed proteins in tissue proteome of CD and ITB. Further experiments are required using a larger cohort of homogeneous tissue samples.

7 Article Frequency, natural course and clinical significance of symptomatic terminal ileitis. 2016

Kedia, Saurabh / Kurrey, Lalit / Pratap Mouli, Venigalla / Dhingra, Rajan / Srivastava, Saurabh / Pradhan, Rajesh / Sharma, Raju / Das, Prasenjit / Tiwari, Veena / Makharia, Govind / Ahuja, Vineet. ·Departments of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India. · Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India. · Department of Pathology, All India Institute of Medical Sciences, New Delhi, India. ·J Dig Dis · Pubmed #26670338.

ABSTRACT: OBJECTIVE: Treatment guidelines for managing symptomatic terminal ileitis (TI) are lacking. We followed up a cohort of symptomatic TI patients to conduct an algorithm for their management. METHODS: Consecutive patients with symptomatic TI from July 2007 to October 2013 were included. Symptomatic TI was defined as isolated terminal ileum ulceration (superficial or deep) and/or nodularity with abdominal symptoms. Patients were diagnosed either with intestinal tuberculosis (ITB) or Crohn's disease (CD) using standard criteria or received only symptomatic treatment according to their clinical manifestations, endoscopic, imaging and histological (specific to ITB/CD vs non-specific) features. Based upon above findings, an algorithm was conducted to differentiate non-specific TI from those with specific etiology (ITB/CD). RESULTS: In all, 63/898 (7.0%) patients with ulcero-constrictive intestinal disease had TI, of which 45 (26 males and 19 females) were included. Fever, diarrhea, weight loss, deep ulcers, and ileal thickening were more frequently observed in patients with ITB or CD having specific treatments compared with those receiving symptomatic treatments. All patients with deep ulcers and those with superficial ulcer and specific histology had ITB/CD. In patients with superficial ulcers and/or nodularity and non-specific inflammation (n = 31), the absence of fever, diarrhea, GI bleeding or weight loss had a negative predictive value of 92% in excluding ITB/CD. CONCLUSIONS: In symptomatic TI patients with superficial ulcers and a non-specific histology, the absence of fever, diarrhea, GI bleeding or weight loss rules out the possibility of significant diagnoses like ITB/CD.

8 Article Tubercular pancreatic abscess: diagnostic dilemma and management. 2013

Mangla, Vivek / George, Joseph / Das, Prasenjit / Dash, Nihar R / Pal, Sujoy / Chattopadhyay, Tushar K. · ·Trop Gastroenterol · Pubmed #24851530.

ABSTRACT: -- No abstract --

9 Article Comparative tight junction protein expressions in colonic Crohn's disease, ulcerative colitis, and tuberculosis: a new perspective. 2012

Das, Prasenjit / Goswami, Pooja / Das, Tapash K / Nag, Tapas / Sreenivas, Vishnubhatla / Ahuja, Vineet / Panda, Subrat K / Gupta, Siddhartha Datta / Makharia, Govind K. ·Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. ·Virchows Arch · Pubmed #22297703.

ABSTRACT: We intended to see the pattern of TJ protein expression along with ultrastructural changes in colonic biopsies from patients with Crohn's disease (CD), ulcerative colitis (UC), and tuberculosis (cTB). Colonic biopsies from 11 patients with active CD and ten patients each with active UC and untreated cTB were taken along with biopsies from six patients with irritable bowel syndrome as controls. These were evaluated for expression pattern of key TJ proteins which included claudin-2 as TJ pore-forming protein, claudin-4 as pore-sealing protein, ZO-1 as scaffold protein, and occludin as TJ protein related to cell migration and polarity. Claudin-2 expression was upregulated along the whole length of intercellular junction (ICJ) in biopsies from patients with active CD and UC in comparison to the biopsies from cTB patients and controls, where its expression was limited to the uppermost part of ICJ. There was reduced expression of ZO-1 in UC, CD, and cTB. On transmission electron microscopic examination, the pentalaminar structure of TJs was destroyed in patients with CD and UC but no significant change was seen in those with cTB and in controls. The expression of claudin-2 was distinctly different in active CD and UC in comparison to its expression pattern in patients with cTB and in controls. The redistribution of claudin-2 expression was in accordance with the TJ ultrastructural changes in patients with UC, CD, and cTB. Altered claudin-2 expression, along with destroyed TJs, may result in loss of selective permeability in patients with UC and CD.

10 Article Clinical, endoscopic, and histological differentiations between Crohn's disease and intestinal tuberculosis. 2010

Makharia, Govind K / Srivastava, Siddharth / Das, Prasenjit / Goswami, Pooja / Singh, Urvashi / Tripathi, Manasee / Deo, Vaishali / Aggarwal, Ashish / Tiwari, Rajeew P / Sreenivas, V / Gupta, Siddhartha Datta. ·Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. govindmakharia@aiims.ac.in ·Am J Gastroenterol · Pubmed #20087333.

ABSTRACT: OBJECTIVES: The clinical, endoscopic, and histological features of Crohn's disease (CD) and intestinal tuberculosis mimic each other so much that it becomes difficult to differentiate between them. The aim was to find out clinical, endoscopic, and histological predictor features for differentiation between CD and intestinal tuberculosis. METHODS: We recruited 106 patients, 53 each with CD and intestinal tuberculosis, in this study. The clinical, histological, and endoscopic features were subjected to univariate, bivariate, and multivariate analyses. On the basis of regression coefficients of the final multivariate logistic model, a score to discriminate between CD and intestinal tuberculosis was devised. For the validation of the score, the same model was tested on 20 new patients, each with CD and intestinal tuberculosis. RESULTS: On univariate analysis, although longer duration of disease, chronic diarrhea, blood in stool, perianal disease, extra-intestinal manifestations, involvement of left colon, skip lesions, aphthous ulcers, cobblestoning, longitudinal ulcers, focally enhanced colitis, and microgranulomas were significantly more common in CD, partial intestinal obstruction, constipation, presence of nodular lesions, higher number, and larger granulomas were significantly more common in intestinal tuberculosis. On multivariate analysis, blood in stool (odds ratio (OR) 0.1 (confidence interval (CI) 0.04-0.5)), weight loss (OR 9.8 (CI 2.2-43.9)), histologically focally enhanced colitis (OR 0.1 (CI 0.03-0.5)), and involvement of sigmoid colon (OR 0.07(0.01-0.3)) were independent predictors of intestinal tuberculosis. On the basis of regression coefficients of the final multivariate logistic model, a score that varied from 0.3 to 9.3 was devised. Higher score predicted more likelihood of intestinal tuberculosis. Once the cutoff was set at 5.1, then the sensitivity, specificity, and ability to correctly classify the two diseases were 83.0, 79.2, and 81.1%, respectively. Area under the curve for receiver-operating characteristic (ROC) to assess the ability of these features to discriminate between CD and intestinal tuberculosis was 0.9089. The area under ROC in the validation data set was 89.2% (95% CI 0.79-0.99). With a similar cutoff score of 5.1, sensitivity and specificity in the validation model were 90% (95% CI 66.9-98.2) and 60% (95% CI 36.4-80.0), respectively. CONCLUSIONS: Blood in stool, weight loss, focally enhanced colitis, and involvement of the sigmoid colon were the most important features in differentiating CD from intestinal tuberculosis.