简化实用算法鉴别克罗恩病与肠结核的高准确性。

High Accuracy of a Simplified, Practical Algorithm in Differentiating Crohn's Disease from Intestinal Tuberculosis.

机构信息

Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.

Department of Medicine, University Malaya, Kuala Lumpur, Malaysia.

出版信息

Dig Dis. 2023;41(4):581-588. doi: 10.1159/000529238. Epub 2023 Jan 26.

DOI:10.1159/000529238

PMID:36702102

Abstract

BACKGROUND

The differentiation between intestinal tuberculosis (ITB) and Crohn's disease (CD) remains a challenge, particularly in areas where tuberculosis is highly prevalent. Previous studies have identified features that favour one diagnosis over the other. The aim of the study was to determine the accuracy of a standardized protocol in the initial diagnosis of CD versus ITB.

METHODS

All patients with suspected ITB or CD were prospectively recruited. A standardized protocol was applied, and the diagnosis was made accordingly. The protocol consists of history and examination, ileocolonoscopy with biopsies, and tuberculosis workup. The diagnosis of probable ITB was made based on at least one positive finding. All other patients were diagnosed as probable CD. Patients were treated either with anti-tubercular therapy or steroids. Reassessment was then carried out clinically, biochemically, and endoscopically. In patients with suboptimal response, the treatment was either switched or escalated depending on the reassessment.

RESULTS

164 patients were recruited with final diagnosis of 30 (18.3%) ITB and 134 (81.7%) CD. 1 (3.3%) out of 30 patients with ITB was initially treated as CD. 16 (11.9%) out of 134 patients with CD were initially treated as ITB. The initial overall accuracy for the protocol was 147/164 (89.6%). All patients received the correct diagnosis by 12 weeks after reassessment.

CONCLUSION

In our population, most patients had CD rather than ITB. The standardized protocol had a high accuracy in differentiating CD from ITB.

摘要

背景

肠结核（ITB）和克罗恩病（CD）的鉴别仍然具有挑战性，尤其是在结核病高发地区。先前的研究已经确定了有利于其中一种诊断的特征。本研究旨在确定标准化方案在 CD 与 ITB 初始诊断中的准确性。

方法

所有疑似 ITB 或 CD 的患者均前瞻性纳入。应用标准化方案进行诊断。该方案包括病史和体格检查、回结肠镜检查和活检以及结核病检查。疑似 ITB 的诊断基于至少一项阳性发现。所有其他患者均被诊断为疑似 CD。患者接受抗结核治疗或类固醇治疗。然后根据临床、生化和内镜检查进行重新评估。对于反应不佳的患者，根据重新评估结果，要么更换治疗方案，要么升级治疗方案。

结果

共纳入 164 例患者，最终诊断为 ITB 30 例（18.3%），CD 134 例（81.7%）。30 例 ITB 患者中有 1 例（3.3%）最初被误诊为 CD。134 例 CD 患者中有 16 例（11.9%）最初被误诊为 ITB。该方案的初始总体准确性为 147/164（89.6%）。所有患者在重新评估后 12 周内均获得正确诊断。