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认识并应对胃肠结核的挑战。

Recognizing and addressing the challenges of gastrointestinal tuberculosis.

作者信息

Kudu Emre, Danış Faruk

机构信息

Emergency Medicine, Marmara University Pendik Training and Research Hospital, İstanbul 34899, Türkiye.

Emergency Medicine, Bolu Abant İzzet Baysal University Medical School, Bolu 14000, Türkiye.

出版信息

World J Clin Cases. 2024 Jul 6;12(19):3648-3653. doi: 10.12998/wjcc.v12.i19.3648.

Abstract

In this editorial, we comment on the article by Ali published in the recent issue of the . This case report shed light on a particularly rare manifestation of this disease-primary gastrointestinal tuberculosis (GTB) presenting as gastric outlet obstruction. GTB presents diagnostic challenges due to its nonspecific symptoms and lack of highly accurate diagnostic algorithms. This editorial synthesizes epidemiological data, risk factors, pathogenesis, clinical presentations, diagnostic methods, and therapies to raise awareness about GTB. GTB constitutes 1%-3% of all tuberculosis cases globally, with 6%-38% of patients also having pulmonary tuberculosis. Pathogenesis involves various modes of Mycobacterium tuberculosis complex entry into the gastrointestinal system, with the terminal ileum and ileocecal valve commonly affected. Clinical presentation varies, often resembling other intra-abdominal pathologies, necessitating a high index of suspicion. Diagnostic tools include a combination of biochemical, microbiological, radiological, and endoscopic assessments. Anti-tubercular medication remains the cornerstone of treatment, supplemented by surgical intervention in severe cases. Multidisciplinary management involving gastroenterologists, surgeons, pulmonologists, and infectious disease specialists is crucial for optimal outcomes. Despite advancements, timely diagnosis and management challenges persist, underscoring the need for continued research and collaboration in addressing primary GTB.

摘要

在这篇社论中,我们对阿里发表在最近一期《 》上的文章进行评论。该病例报告揭示了这种疾病一种极为罕见的表现形式——以胃出口梗阻为表现的原发性胃肠道结核(GTB)。由于GTB症状不具特异性且缺乏高度准确的诊断算法,因此在诊断方面存在挑战。这篇社论综合了流行病学数据、危险因素、发病机制、临床表现、诊断方法及治疗手段,以提高对GTB的认识。GTB占全球所有结核病病例的1% - 3%,6% - 38%的患者同时患有肺结核。发病机制涉及结核分枝杆菌复合体进入胃肠道系统的多种方式,回肠末端和回盲瓣通常受累。临床表现各异,常与其他腹腔内疾病相似,因此需要高度怀疑。诊断工具包括生化、微生物学、放射学和内镜评估的综合应用。抗结核药物仍然是治疗的基石,严重病例辅以手术干预。由胃肠病学家、外科医生、肺科医生和传染病专家参与的多学科管理对于实现最佳治疗效果至关重要。尽管取得了进展,但及时诊断和管理方面的挑战依然存在,这凸显了在应对原发性GTB方面持续开展研究与合作的必要性。

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本文引用的文献

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World J Clin Cases. 2024 Mar 16;12(8):1536-1543. doi: 10.12998/wjcc.v12.i8.1536.
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