Endoscopic features and treatment response have better prediction rate than clinical symptoms/signs in distinguishing Crohn's disease and intestinal tuberculosis. Issue 4 (15th December 2017)

• Record Type: Journal Article
• Authors: Lin, Wei‐Chen; Chang, Chen‐Wang; Wang, Tsang‐En; Wang, Horng‐Yuan; Shih, Shou‐Chuan; Chu, Cheng‐Hsin; Hsu, Tzu‐Chi
• Is Part Of: Advances in digestive medicine. Volume 4:Issue 4(2017)
• Page Start: 121
• Page End: 127
• Publication Date: 2017-12-15
• Subjects: Crohn's disease -- Endoscopic features -- Intestinal tuberculosis; Digestive organs -- Diseases -- Periodicals; Gastrointestinal system -- Diseases -- Periodicals; Gastrointestinal Diseases; Digestive System Diseases; Digestive organs -- Diseases; Gastrointestinal system -- Diseases; Electronic journals; Periodical; Periodicals; Fulltext; Internet Resources; Periodicals; 616.3005
• DOI: 10.1002/aid2.12121
• Languages: English
• ISSNs: 2351-9797

Abstract

Summary: Background: Intestinal tuberculosis (ITB) is less common than Crohn's disease (CD) in Taiwan. Despite the worldwide decline in TB incidence over last several years, the prevalence yet remains high. Therefore, there is a necessity to increase the clinical awareness of this serious health problem. The aim of this study was to investigate the value of clinical methods that may be helpful in distinguishing CD from ITB. Methods: Eighty‐five patients, 67 and 18 patients diagnosed with CD and ITB, respectively, from January 2000 to April 2015 at Mackay Memorial Hospital, Taipei were included. The clinical, laboratory, endoscopic, and histological characteristics were reviewed retrospectively. Results: CD patients (33 ± 13 years) were younger than ITB patients (57 ± 21 years) ( p = 0.103). The incidences of hematochezia, abdominal pain, diarrhea, fever, and weight loss were not significantly different ( p = 0.388, p = 0.699, p = 0.751, p = 0.468, and p = 0.611, respectively). The hemoglobin, platelet, and C‐reactive protein (CRP) levels were also not significantly different ( p = 0.388, p = 0.440, and p = 0.330, respectively). The endoscopic features of aphthous ulcer and cobblestone appearance were seen more often in CD patients ( p = 0.043 and p = 0.010, respectively). Rectal lesions (29.9 vs. 0%; p = 0.020) were seen only in CD patients. Patulous ileocecal valve was specifically seen in ITB patients ( p = 0.006). The histological features of granuloma, cryptitis and crypt abscess, and fissure formation were not significantly different ( p = 0.377, p = 0.293, and p = 0.212, respectively). Conclusions: The endoscopic features of aphthous ulcerations, cobblestone appearance, and rectal involvement in CD and of patulous ileocecal valve in ITB, along with clinical treatment follow‐up, tend to be useful diagnostic characteristics differentiating CD and ITB. Copyright © 2017, The Gastroenterological Society of Taiwan, The Digestive Endoscopy Society of Taiwan and Taiwan Association for the Study of the Liver.