Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Curr Opin Infect Dis. 2024 Oct 1;37(5):392-401. doi: 10.1097/QCO.0000000000001054. Epub 2024 Aug 6.
Despite advances in our radiological, histological and microbiological armamentarium, distinguishing between Crohn's disease (CD) and intestinal tuberculosis (ITB), especially in a TB endemic country, continues to be a challenging exercise in a significant number of patients. This review aims to summarize current available evidence on novel diagnostic techniques which have a potential to fill the gap in our knowledge of differentiating between ITB and CD.
Both ITB and CD are associated with altered host immune responses, and detection of these altered innate and adaptive immune cells has potential to distinguish ITB from CD. ITB and CD have different epigenetic, proteomic and metabolomic signatures, and recent research has focused on detecting these differences. In addition, the gut microbiome, which is involved in mucosal immunity and inflammatory responses, is considerably altered in both ITB and CD, and is another potential frontier, which can be tapped to discriminate between the two diseases. With technological advancements, we have newer radiological modalities including perfusion CT and dual-layer spectral detector CT enterography and evidence is emerging of their role in differentiating ITB from CD. Finally, time will tell whether the advent of artificial intelligence, with rapidly accumulating data in this field, will be the gamechanger in solving this puzzle of diagnostic dilemma between ITB and Crohn's disease.
Recent advances need to be clinically validated before they can be used as novel diagnostic measures to differentiate Intestinal TB from CD.
尽管我们在影像学、组织学和微生物学方面取得了进展，但在放射武器库中，要区分克罗恩病（CD）和肠结核（ITB），尤其是在结核病流行的国家，仍然是一项具有挑战性的任务，对于许多患者来说，这仍然是一项具有挑战性的任务。本文旨在总结目前关于新的诊断技术的现有证据，这些技术有可能填补我们在区分 ITB 和 CD 方面的知识空白。
ITB 和 CD 均与宿主免疫反应改变有关，检测这些改变的固有和适应性免疫细胞有可能区分 ITB 和 CD。ITB 和 CD 具有不同的表观遗传、蛋白质组学和代谢组学特征，最近的研究集中在检测这些差异上。此外，肠道微生物组参与黏膜免疫和炎症反应，在 ITB 和 CD 中均发生了很大的改变，这是另一个潜在的前沿领域，可以用来区分这两种疾病。随着技术的进步，我们有了新的影像学方式，包括灌注 CT 和双层光谱探测器 CT 肠造影术，这些方法在区分 ITB 和 CD 方面的作用正在显现。最后，时间将证明人工智能的出现，以及该领域快速积累的数据，是否会成为解决 ITB 和 CD 之间诊断困境这一难题的游戏规则改变者。
在将这些新技术作为新的诊断措施用于区分肠结核和 CD 之前，需要对其进行临床验证。
