Analysis of Colonoscopic Findings in the Differential Diagnosis Between Intestinal Tuberculosis and Crohn’s Disease

Background and Study Aims: Intestinal tuberculosis and Crohn’s disease are chronic inflammatory bowel disorders that are difficult to differentiate from one another. This study aimed to evaluate the diagnostic value of various colonoscopic findings in the differential diagnosis between intestinal tuberculosis and Crohn’s disease.
Patients and Methods: Colonoscopic findings on initial work-up were prospectively recorded in patients with an initial diagnosis of either intestinal tuberculosis or Crohn’s disease. These findings were analyzed after a final diagnosis of intestinal tuberculosis (n = 44) or Crohn’s disease (n = 44) had been made after follow-up.
Results: Four parameters (anorectal lesions, longitudinal ulcers, aphthous ulcers, and cobblestone appearance) were significantly more common in patients with Crohn’s disease than in patients with intestinal tuberculosis. Four other parameters (involvement of fewer than four segments, a patulous ileocecal valve, transverse ulcers, and scars or pseudopolyps) were observed more frequently in patients with intestinal tuberculosis than in patients with Crohn’s disease. We hypothesized that a diagnosis of Crohn’s disease could be made when the number of parameters characteristic of Crohn’s disease was higher than the number of parameters characteristic of intestinal tuberculosis, and vice versa. Making these assumptions, we calculated that the diagnosis of either intestinal tuberculosis or Crohn’s disease would have been made made correctly in 77 of our 88 patients (87.5 %), incorrectly in seven patients (8.0 %), and would not have been made in four patients (4.5 %).
Conclusions: A systematic analysis of colonoscopic findings is very useful in the differential diagnosis between intestinal tuberculosis and Crohn’s disease.

References

• 1 Horvath K D, Whelan R L. Intestinal tuberculosis: return of an old disease.  Am J Gastroenterol. 1998;  93 692-696
• 2 Marshall J B. Tuberculosis of the gastrointestinal tract and peritoneum.  Am J Gastroenterol. 1993;  88 989-999
• 3 Snider D E Jr, Roper W L. The new tuberculosis.  N Engl J Med. 1992;  326 703-705
• 4 Rieder H L, Cauthen G M, Kelly G D. et al . Tuberculosis in the United States.  JAMA. 1989;  262 385-389
• 5 Leong R W, Lau J Y, Sung J J. The epidemiology and phenotype of Crohn’s disease in the Chinese population.  Inflamm Bowel Dis. 2004;  10 646-651
• 6 Yang S K, Loftus E V Jr, Sandborn W J. Epidemiology of inflammatory bowel disease in Asia.  Inflamm Bowel Dis. 2001;  7 260-270
• 7 Morita N, Toki S, Hirohashi T. et al . Incidence and prevalence of inflammatory bowel disease in Japan: nationwide epidemiological survey during the year 1991.  J Gastroenterol. 1995;  30 (Suppl 8) 1-4
• 8 Ghosh P. Tuberculosis of the gastrointestinal tract. In: Allan RN, Rhodes JM, Hanauer SB et al. (eds) Inflammatory bowel diseases. 3rd edn. New York; Churchill Livingstone 1997: 391-398
• 9 Hoshino M, Shibata M, Goto N. et al . A clinical study of tuberculous colitis.  Gastroenterol Jpn. 1979;  14 299-305
• 10 Lee Y J, Yang S K, Myung S J. et al . The usefulness of colonoscopic biopsy in the diagnosis of intestinal tuberculosis and pattern of concomitant extra-intestinal tuberculosis.  Korean J Gastroenterol. 2004;  44 153-159
• 11 Yang S K. Current status and clinical characteristics of inflammatory bowel disease in Korea.  Korean J Gastroenterol. 2002;  40 1-14
• 12 Tonghua L, Guozong P, Minzhang C. Crohn’s disease: clinicopathologic manifestations and differential diagnosis from enterocolonic tuberculosis.  Chinese Med J. 1981;  94 431-440
• 13 Chutkan R K, Scherl E, Waye J D. Colonoscopy in inflammatory bowel disease.  Gastrointest Endosc Clin N Am. 2002;  12 463-483
• 14 Silverstein F E, Tytgat G NJ. Gastrointestinal endoscopy. 3rd edn. London; Mosby-Wolfe 1997
• 15 Naga M I, Okasha H H, Ismail Z. et al . Endoscopic diagnosis of colonic tuberculosis.  Gastrointest Endosc. 2001;  53 789-793
• 16 Singh V, Kumar P, Kamal J. et al . Clinicocolonoscopic profile of colonic tuberculosis.  Am J Gastroenterol. 1996;  91 565-568
• 17 Shah S, Thomas V, Mathan M. et al . Colonoscopic study of 50 patients with colonic tuberculosis.  Gut. 1992;  33 347-351
• 18 Bhargava D K, Kushwaha A K, Dasarathy S. et al . Endoscopic diagnosis of segmental colonic tuberculosis.  Gastrointest Endosc. 1992;  38 571-574
• 19 Lingenfelser T, Zak J, Marks I N. et al . Abdominal tuberculosis: still a potentially lethal disease.  Am J Gastroenterol. 1993;  88 744-750
• 20 Loftus E V Jr, Silverstein M D, Sandborn W J. et al . Crohn’s disease in Olmsted County, Minnesota, 1940 - 1993: incidence, prevalence, and survival.  Gastroenterology. 1998;  114 1161-1168
• 21 Tandon H D, Prakash A. Pathology of intestinal tuberculosis and its distinction from Crohn’s disease.  Gut. 1972;  13 260-269
• 22 Jayanthi V, Robinson R J, Malathi S. et al . Does Crohn’s disease need differentiation from tuberculosis?.  J Gastroenterol Hepatol. 1996;  11 183-186
• 23 Pulimood A B, Ramakrishna B S, Kurian G. et al . Endoscopic mucosal biopsies are useful in distinguishing granulomatous colitis due to Crohn’s disease from tuberculosis.  Gut. 1999;  45 537-541
• 24 Gan H T, Chen Y Q, Ouyang Q. et al . Differentiation between intestinal tuberculosis and Crohn’s disease in endoscopic biopsy specimens by polymerase chain reaction.  Am J Gastroenterol. 2002;  97 1446-1451
• 25 Lee F D, Roy A D. Ileo-caecal granulomata.  Gut. 1964;  19 517-523
• 26 Tan M F, Ng W C, Chan S H. et al . Comparative usefulness of PCR in the detection of Mycobacterium tuberculosis in different clinical specimens.  J Med Microbiol. 1997;  46 164-169
• 27 Condos R, McClune A, Rom W N. et al . Peripheral-blood-based PCR assay to identify patients with active pulmonary tuberculosis.  Lancet. 1996;  347 1082-1085