Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea.
Division of Gastroenterology, Department of Internal Medicine, Center for Health Promotion, Seoul National University Hospital, Seoul 03080, South Korea.
World J Gastroenterol. 2017 Sep 14;23(34):6306-6314. doi: 10.3748/wjg.v23.i34.6306.
To investigate the temporal trends in the misdiagnosis rate between Crohn's disease (CD) and intestinal tuberculosis (ITB) in South Korea.
We retrospectively reviewed the medical records of patients managed for CD or ITB at Asan Medical Center, a tertiary referral hospital, Seoul, Korea between 1996 and 2014. The temporal trends in the misdiagnosis rates between the two diseases were analyzed. The demographic and clinical characteristics were compared between CD patients who were initially misdiagnosed as ITB (final CD group) and vice versa (final ITB group). Final diagnostic criteria for ITB and medication for CD before definite diagnosis of TB were also analyzed in final ITB group.
In total, 2760 patients were managed for CD and 772 patients for ITB between 1996 and 2014. As well, 494 of the 2760 CD patients (17.9%) were initially misdiagnosed as ITB and 83 of the 772 ITB patients (10.8%) as CD. The temporal trend in misdiagnosing CD as ITB showed a decrease (OR = 0.89, 95%CI: 0.87-0.91, < 0.001), whereas the temporal trend in misdiagnosing ITB as CD showed an increase (OR = 1.06, 95%CI: 1.01-1.11, = 0.013). Age at diagnosis, presenting symptoms, and proportion of patients with active/past perianal fistula and active/inactive pulmonary tuberculosis (TB) were significantly different between final CD group and final ITB group. Forty patients (48.2%) in final ITB group were diagnosed by favorable response to empirical anti-TB treatment. Seventeen patients (20.5%) in final ITB group had inappropriately received corticosteroids and/or thiopurines due to misdiagnosis as CD. However, there were no mortalities in both groups.
Cases of CD misdiagnosed as ITB have been decreasing, whereas cases of ITB misdiagnosed as CD have been increasing over the past two decades.
探讨韩国克罗恩病（CD）和肠结核（ITB）误诊率的时间趋势。
我们回顾性分析了 1996 年至 2014 年在韩国首尔的三级转诊医院——Asan 医疗中心接受 CD 或 ITB 治疗的患者的病历。分析了两种疾病误诊率的时间趋势。比较了最初误诊为 ITB 的 CD 患者（最终 CD 组）和误诊为 CD 的 ITB 患者（最终 ITB 组）的人口统计学和临床特征。还分析了最终 ITB 组中 ITB 的最终诊断标准和 CD 确诊前的药物治疗。
1996 年至 2014 年，共有 2760 例 CD 患者和 772 例 ITB 患者接受治疗。此外，2760 例 CD 患者中有 494 例（17.9%）最初误诊为 ITB，772 例 ITB 患者中有 83 例（10.8%）误诊为 CD。误诊 CD 为 ITB 的时间趋势呈下降趋势（OR = 0.89，95%CI：0.87-0.91， < 0.001），而误诊 ITB 为 CD 的时间趋势呈上升趋势（OR = 1.06，95%CI：1.01-1.11， = 0.013）。两组间诊断时的年龄、临床表现以及有活动性/既往肛周瘘管和活动性/非活动性肺结核（TB）的患者比例有显著差异。最终 ITB 组中有 40 例（48.2%）患者因经验性抗结核治疗效果良好而确诊。最终 ITB 组中有 17 例（20.5%）患者因误诊为 CD 而不恰当地接受了皮质类固醇和/或硫嘌呤类药物治疗。然而，两组均无死亡病例。
在过去的二十年中，CD 误诊为 ITB 的病例有所减少，而 ITB 误诊为 CD 的病例有所增加。
