Colon tuberculosis: endoscopic features and prospective endoscopic follow-up after anti-tuberculosis treatment

Tuberculosis (TB) is still common in many countries and there has been a resurgence of TB in the developed nations. Although small bowel is the most commonly affected gastrointestinal organ, increasing numbers of cases are being described with colon TB. There are limited prospective studies looking at the outcomes of colon lesions, especially after anti-TB treatment. Our aim was to evaluate the endoscopic features of TB of the colon and to prospectively follow up the endoscopic response of colon lesions to anti-TB treatment.

From October 2004 to December 2010 consecutive patients presenting with colon TB to one tertiary care center in India were enrolled. Demographic, clinical data, and lesions identified on colonoscopy were recorded. Anti-TB treatment was started and follow-up colonoscopy was performed within 4 weeks after completion of anti-TB treatment. Post-treatment endoscopic features and clinical outcomes were noted.

Sixty-nine consecutive patients with colon TB were enrolled (mean age 39.3±14.8 years; male 45, female 24). Presenting clinical features included abdominal pain 80.6%, weight loss 74.6%, fever 40.3%, diarrhea/constipation 25.4%, diarrhea 16.4%, blood per rectum 11.9%, abdominal tenderness 37.3%, abdominal mass 13.4%, and lymphadenopathy 1.5%. Macroscopic lesions on endoscopy were predominantly right-sided (cecum and ascending colon) and primarily ulcers (ulcers 88.0%, nodules 50.7%, luminal narrowing 44.8%, polypoid lesion 10.4%). Majority of the ulcers (87.2%), nodules (84.6%), polypoid lesions (85.7%), luminal narrowing (76.2%), and ileo-cecal valve deformities (76.5%) resolved with anti-TB treatment.

TB of the colon predominantly affects the cecum and the ascending colon. Ulceration, nodularity, and stricture are the prominent endoscopic findings. Majority of the lesions heal with anti-TB treatment.