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Diagnosing Intestinal Tuberculosis and Crohn's Disease in Children in a tuberculosis endemic Country: A Daunting
Nadira Musabbir1, Fahmida Begum1, Wahiduzzaman Mazumder1
1Department of Pediatric Gastroenterology and Nutrition, Bangladesh Medical University, Dhaka, Bangladesh.
Insights
Distinguishing pediatric intestinal tuberculosis (ITB) from Crohn
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Inflammatory Bowel Disease
Background:
- Intestinal tuberculosis (ITB) and Crohn's disease (CD) are chronic inflammatory conditions affecting children.
- Differentiating between ITB and CD in pediatric patients can be challenging due to overlapping clinical presentations.
- Accurate diagnosis is crucial for appropriate treatment and management to prevent long-term complications.
Purpose of the Study:
- To compare the clinical, laboratory, endoscopic, and histological features of children diagnosed with ITB and CD.
- To identify key differentiating factors that aid in the differential diagnosis between pediatric ITB and CD.
- To improve diagnostic accuracy for these conditions in pediatric populations.
Main Methods:
- A single-center retrospective study conducted between January 2021 and December 2023.
- Inclusion of pediatric patients diagnosed with either ITB or CD.
- Comparison of baseline demographics, clinical symptoms, laboratory findings, endoscopic results, and histological data.
Main Results:
- The study included 28 ITB patients and 21 CD patients.
- ITB patients more frequently presented with fever, subacute intestinal obstruction, and a history of contact.
- CD patients exhibited higher rates of nocturnal stooling, growth failure, extraintestinal manifestations, perianal involvement, elevated fecal calprotectin, and specific endoscopic findings like aphthous ulcers, skip lesions, and cobble-stoning.
Conclusions:
- Clinical features, laboratory markers, and endoscopic findings are essential for differentiating pediatric ITB from CD.
- A comprehensive evaluation combining these aspects is necessary for accurate diagnosis.
- Further research may refine diagnostic criteria and improve patient outcomes.
Objective:
This study aimed to analyze the clinical, laboratory, endoscopic, and histological features of children with intestinal tuberculosis (ITB) and Crohn's disease (CD).
Materials And Methods:
This single-center retrospective study was done among children with ITB and CD between January 2021 and December 2023. Their baseline demographics, clinical, laboratory, endoscopic, and histological findings were compared.
Results:
This study included 28 ITB and 21 CD patients. The prevalence of fever (57.1% vs. 14.3%; P=.003), subacute intestinal obstruction (21.4% vs. 0%; P=.031), and positive contact history (25% vs. 0%; P=.015) was more common in ITB patients, whereas nocturnal stooling (33.3% vs. 0%; P=.001), growth failure (66.7% vs. 35.7%; P=.032), extraintestinal manifestation (28.6% vs. 3.6%; P=.033), perianal involvement (33.3% vs. 7.1%; P=.028) predominated in CD patients with longer disease duration (7.3 ± 3.3 months vs. 5.1 ± 4.02 months; P=.003). Higher mean fecal calprotectin level (1145.45 ± 660.45 vs. 566.22 ± 299.18 ug/g; P=.002), left-sided colonic involvement with linear ulcer (42.9% vs. 7.1%; P=.005), aphthous ulcer (38.1% vs. 7.1%; P=.012), skip lesion (28.6% vs. 0%; P=.004), cobble-stoning (19% vs. 0%; P=.028), perianal lesion (33.3% vs. 7.1%; P=.028), and focally enhanced colitis (47.6% vs. 0%; P=.000) were more common in CD patients than ITB patients.
Conclusion:
A combination of clinical features, laboratory tests, and endoscopic evaluation is needed to accurately distinguish CD from ITB in children.
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