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Differentiating intestinal tuberculosis from Crohn's disease: a diagnostic challenge
Majid Abdulrahman Almadi1, Subrata Ghosh, Abdulrahman Mohamed Aljebreen
1Gastroenterology Division, McGill University Health Center, McGill University, Montreal, Canada.
The American Journal of Gastroenterology
|February 26, 2009
Summary
Differentiating Crohn's disease (CD) and intestinal tuberculosis (ITB) is challenging due to changing epidemiology. This review offers insights into diagnostic tools and proposes an algorithm to improve accuracy and reduce misdiagnosis risks.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Epidemiology
Background:
- Crohn's disease (CD) and intestinal tuberculosis (ITB) share overlapping clinical and epidemiological features, complicating diagnosis.
- Increasing diagnostic challenges lead to high morbidity and mortality from delayed or misdiagnosis.
Purpose of the Study:
- To review epidemiological trends of CD and ITB.
- To highlight clinical, laboratory, radiological, endoscopic, and pathological features for differentiating CD and ITB.
- To propose a diagnostic algorithm for suspected cases.
Main Methods:
- Review of epidemiological trends.
- Analysis of clinical manifestations and diagnostic tests including laboratory, serological, tuberculin skin tests, and interferon-gamma-release assay (QuantiFERON-TB Gold).
- Evaluation of radiological, endoscopic, and pathological findings.
Main Results:
- Discusses the utility of QuantiFERON-TB Gold in BCG-vaccinated populations.
- Examines the association between mycobacteria and CD.
- Addresses concerns regarding empirical anti-tuberculosis treatment and anti-tumor necrosis factor-alpha agent-induced extrapulmonary TB.
Conclusions:
- Accurate differentiation between CD and ITB is crucial for effective patient management.
- The proposed algorithm aims to guide clinicians in the diagnostic workup.
- Understanding epidemiological shifts and diagnostic nuances is key to improving outcomes.
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