Patel Bhumit, Yagnik Vipul D
Department of Medical Gastroenterology, Akshar Bhoomi Liver and Gastro Care, Ahmedabad, Gujarat, India.
Department of Surgical Gastroenterology, Ronak Endo-laparoscopy and General Surgical Hospital, Patan, Gujarat, India.
Clin Exp Gastroenterol. 2018 Mar 13;11:97-103. doi: 10.2147/CEG.S154235. eCollection 2018.
BACKGROUND/AIMS: As increasing numbers of Crohn's disease (CD) cases are being recognized in India, so the differential diagnosis of CD and gastrointestinal tuberculosis (GITB) is becoming increasingly important. If patients are misdiagnosed with GITB, toxicity may result from unnecessary anti-TB therapy and treatment of the primary disease (ie, CD) gets delayed. We therefore aimed to assess the accuracy of various parameters that can be used to predict GITB diagnosis at index evaluation.
This was a prospective, unicentric, observational study carried out in the gastroenterology department of a tertiary care hospital between August 2011 and January 2013. Patients who presented to our hospital and were suspected of having GITB were included in our study. Patients were then followed up over a 6-month period.
Chi-square test was used to analyze the data.
Of the 69 patients with GITB, 49 (71.01%) had thickening of the involved part of the colon and 33 (47.83%) had abdominal lymphadenopathy. The ileocecal valve was involved in 58 patients (84.05%) Histological detection of granulomas had 78.95% specificity, 36.23% sensitivity, and 51.40% accuracy. Tuberculosis polymerase chain reaction was found to have 78.95% specificity, 71.01% sensitivity, and 73.83% accuracy. BACTEC-MGIT culture was found to have 100% specificity, 20.29% sensitivity, and 48.60% accuracy.
Although histology is helpful in ruling out other conditions, TB-specific findings such as caseating granuloma and acid-fast bacilli are rarely seen. Instead, tuberculosis polymerase chain reaction has the highest diagnostic accuracy followed by BACTEC culture.
背景/目的：随着印度克罗恩病（CD）确诊病例数的不断增加，CD与胃肠道结核（GITB）的鉴别诊断变得越发重要。若患者被误诊为GITB，不必要的抗结核治疗可能导致毒性反应，同时原发性疾病（即CD）的治疗也会延误。因此，我们旨在评估在首次评估时可用于预测GITB诊断的各种参数的准确性。
这是一项前瞻性、单中心观察性研究，于2011年8月至2013年1月在一家三级护理医院的胃肠病科开展。到我院就诊且疑似患有GITB的患者被纳入本研究。随后对患者进行为期6个月的随访。
采用卡方检验分析数据。
69例GITB患者中，49例（71.01%）受累结肠部位增厚，33例（47.83%）有腹部淋巴结肿大。回盲瓣受累58例（84.05%）。肉芽肿的组织学检测特异性为78.95%，敏感性为36.23%，准确性为51.40%。结核聚合酶链反应特异性为78.95%，敏感性为71.01%，准确性为73.83%。BACTEC - MGIT培养特异性为100%，敏感性为20.29%，准确性为48.60%。
尽管组织学有助于排除其他病症，但很少能见到结核特异性表现，如干酪样肉芽肿和抗酸杆菌。相比之下，结核聚合酶链反应诊断准确性最高，其次是BACTEC培养。
