Thai Journal of Gastroenterology

Article :
Differentiation Between Ileocecal Tuberculosis and Crohn’s Disease using a Combination of Clinical, Endoscopic and Histological Characteristics

Author :
Anuchapreeda S
Pongprasobchai S
Leelakusolvong S
Pausawasdi N
Charatcharoenwitthaya P
Prachayakul V
Nimanong S
Chotiyaputta W
Chainuvati S
Tanwandee T
Manatsathit S
Kachintorn U

Abstract :

Background:    Differentiation between ileocolonic tuberculosis (TB) and Crohn’s disease (CD) is difficult but very important.  Data on this issue is scarce and inconsistent.

Methods:    Clinical, endoscopic and biopsy results of 27 TB patients and 33 CD patients were analyzed and compared.

Results:    The only useful clinical feature to distinguish TB from CD was host immune status (odds ratio 51 for CD, p <0.001).  The presence of immunocompetency was associated with sensitivity, specificity, PPV and NPV of 100%, 39%, 68% and 0%, respectively for the diagnosis of CD.  The only endoscopic feature that helped distinguishing CD from TB was the number of ulcers of 4 or more (odds ratio 4.67 for CD, 95% CI 1.12-19.54, p =
0.004), with sensitivity, specificity, PPV and NPV of 84%, 47%, 70% and 33%, respectively for CD.  A single biopsy session, together with searching for evidence of extraintestinal TB led to the diagnosis of TB in all patients, whereas in CD, even multiple colonoscopies and biopsy sessions could definitely diagnose CD in only 11.8%.

Conclusion:    Patient immune status, number of ulcers and result of single biopsy session could distinguish ileocolonic CD from TB in most patients.

Keyword :
clinical, Crohn’s disease, differentiate, distinguish, endoscopy, histology, tuberculosis

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