Histological approach and differentiation of Crohn's disease and gastrointestinal tuberculosis: Recommendations from the joint IAPM-ISG-CCFI Working Group
Prasenjit Das1, Puja Sakhuja2, Aminder Singh3
1Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110 029, India. prasenaiims@gmail.com.
Insights
Standardized pathology guidelines for differentiating Crohn's disease (CD) and gastrointestinal tuberculosis (GI TB) in Southeast Asia are crucial. These recommendations aim to improve diagnostic accuracy and patient management for these challenging ulcero-stricturing diseases.
Area of Science:
- Gastroenterology
- Pathology
- Infectious Diseases
Background:
- Crohn's disease (CD) and gastrointestinal tuberculosis (GI TB) are common causes of ulcero-stricturing diseases in Southeast Asia.
- Distinguishing CD from GI TB is difficult due to overlapping clinical, endoscopic, radiological, and histological features.
- Standardization of mucosal biopsy sampling, processing, and interpretation is needed for accurate diagnosis.
Purpose of the Study:
- To develop comprehensive recommendations for pathologists to differentiate Crohn's disease from gastrointestinal tuberculosis.
- To standardize biopsy protocols, histological interpretation, and reporting for these challenging conditions.
Main Methods:
- A structured Delphi process was employed.
- Core subject experts from relevant Indian professional societies collaborated.
- Recommendations were based on literature reviews, virtual meetings, online voting, and a physical meeting.
Main Results:
- Comprehensive recommendations for differentiating CD from GI TB were formulated.
- The guidelines provide a ready reference for specialists and pathologists.
- The aim is to standardize luminal gastroenterology practice and promote uniformity.
Conclusions:
- These multi-society, evidence-based recommendations promote uniformity and confidence in pathology reports.
- Standardized reporting facilitates timely patient management.
- Accurate differentiation prevents complications from erroneous treatment.
Background:
The most common causes for ulcero-stricturing diseases of the ileo-cecal region and colon in Southeast Asia are Crohn's disease (CD) and gastrointestinal tuberculosis (GI TB). Diagnosing these conditions is challenging because they share several clinical, endoscopic, radiological and histological features on mucosal biopsies. Therefore, there is a need to standardize the sampling, processing and interpretation of mucosal biopsies to aid clinical decision-making.
Methods:
Recognizing this challenge, core subject experts nominated by the Indian Association of Pathologists and Microbiologists (IAPM), the Indian Society of Gastroenterology (ISG) and the Colitis and Crohn's Foundation, India (CCFI), collaborated to formulate comprehensive recommendations for pathologists regarding optimal biopsy protocols, histological interpretation and reporting for differentiating CD from GI TB. A structured Delphi process was followed.
Results:
The recommendations from the core domain expert groups were based on discussions, brainstorming sessions and extensive literature reviews conducted over three virtual group meetings, multiple online voting sessions and one physical meeting involving all experts. This document is expected to standardize the practice of luminal gastroenterology by providing a ready reference for budding specialists and pathologists, thereby promoting uniformity in practice.
Conclusion:
These multi-society, evidence-based and practically applicable recommendations developed by core subject experts aim to promote uniformity and confidence in pathology reports, facilitate timely patient management and prevent complications arising from erroneous treatment.
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