Year 2018 / Volume 110 / Number 10
Review
Intestinal tuberculosis and Crohn’s disease: the importance and difficulty of a differential diagnosis

650-657

DOI: 10.17235/reed.2018.5184/2017

Esther Merino Gallego, Francisco Gallardo Sánchez, Francisco Javier Gallego Rojo,

Abstract
Tuberculosis (TB) is the most prevalent infection worldwide and affects one third of the population, predominantly in developing countries. Intestinal TB (ITB) is the sixth most frequent extra-pulmonary TB infection. Crohn’s disease (CD) is a chronic inflammatory bowel disease that arises from the interaction of immunological, environmental and genetic factors. Due to changes in the epidemiology of both diseases, distinguishing CD from ITB is a challenge, particularly in immunocompromised patients and those from areas where TB is endemic. Furthermore, both TB and CD have a predilection for the ileocecal area. In addition, they share very similar clinical, radiological and endoscopic findings. An incorrect diagnosis and treatment may increase morbidity and mortality. Thus, a great degree of caution is required as well as a familiarity with certain characteristics of the diseases, which will aid the differentiation between the two diseases.
Share Button
New comment
Comments
No comments for this article
References
1)Kirsch R, Pentecost M, Hall PM et al. Role of colonoscopic biopsy in distinguishing between Crohn’s disease and intestinal tuberculosis. J Clin Pathol 2006,59:840-4.
2) Di Lauro S, Crum-Cianflone N. Ileitis: When it is not Crohn’s disease. Curr Gastroenterol Rep 2010;12(4):249-258.
3) Gomollón F, Dignass A, Annese V, et al. 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn’s Disease 2016: Part 1: Diagnosis and Medical Management. Journal of Crohn's and Colitis, 2017, 3–25.
4) Donoghue HD, Holton J. Intestinal tuberculosis. Curr Opin Infect Dis 2009;22:490-6.
5)MA JY, Tong JL, RAN ZH, et al. Intestinal tuberculosis and Crohn’s disease: challenging differential diagnosis. Journal of Digestive Diseases 2016;17:155-161.
6) Rodríguez Valín E, Villarrubia Enseñat S, Martínez Sánchez E, et al. Centro Nacional de Epidemiología. Instituto de Salud Carlos III. Informe epidemiológico sobre la situación de la tuberculosis en España. Año 2014. Madrid, 2015. [Consultado el 10 mar 2018]. Disponible en: www.isciii.es/ISCIII/es/contenidos/fd-servicios-cientifico-tecnicos/fd-vigilancias-alertas/fd-enfermedades/pdf_2015/TB_Informe_2014.pdf
7)WHO (World Health Organization) [Internet]. [consultado2018 Ene 10]. Disponible en: http://apps.who.int/gho/data/node.main.1315?lang=en.
8)Abdulrahman Almadi M, Ghosh S, Mohamed Aljebreen A. Differentiating intestinal tuberculosis from Crohn’s disease: a diagnostic challenge. Am J Gastroenterol 2010;104:1003-1012.
9)Marehbian J, Arrighi HM, Hass S, et al. Adverse events associated with common therapy regimens for moderate-to-severe Crohn’s disease. Am J Gastroenterol. 2009;104:2524---33
10)Horsburgh CR, Rubin EJ. Clinical practice. Latent tuberculosis infection in the United States. N Engl J Med. 2011;364:1441-8
11)Riestra S, De Francisco R, Arias-Guillén M et al. Risks factors for tuberculosis in inflammatory bowel disease: anti-tumor necrosis factor and hospitalization. Rev Esp Enferm Dig 2016;108(9):541-549.
12)Carpio D, Jauregui-Amezaga A, de Francisco R, de Castro L, Barreiro-de Acosta M, Mendoza JL, Mañosa M, Ollero V, Castro B, González-Conde B, Hervías D, Sierra Ausin M, Sancho Del Val L, Botella-Mateu B, Martínez-Cadilla J, Calvo M, Chaparro M, Ginard D, Guerra I, Maroto N, Calvet X, Fernández-Salgado E, Gordillo J, Rojas Feria M; GETECCU.. Tuberculosis in Anti-Tumour Necrosis Factor-treated Inflammatory Bowel Disease Patients After the Implementation of Preventive Measures: Compliance With Recommendations and Safety of Retreatment. J Crohns Colitis. 2016 Oct;10(10):1186-93. doi: 10.1093/ecco-jcc/jjw022.
13)Abreu C, Magro F, Santos-Antunes J, et al. Tuberculosis in anti-TNF- treated patients remains a problem in countries with an intermediate incidence: Analysis of 25 patients matched with a control population. J Crohns Colitis. 2013;7:e486---92.
14)Riestra S, Taxonera C, Carpio D et al. Recomendaciones del Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa (GETECCU) sobre el cribado y tratamiento de la tuberculosis latente en pacientes con enfermedad inflamatoria intestinal. Enferm inflam intest dia 2015;14(3):109-119.
15)Patel N, Amarapurkar D, Agal S et al. Gastrointestinal luminal tuberculosis: establishing the diagnosis. J gastroenterol Hepatol 2004;19:1240-6.
16)Epstein D, Watermeyer G, Kirsch R. Review article: the diagnosis and management of Crohn’s disease in populations with high-risk rates for tuberculosis. Aliment Pharmacol Ther 2007;25:1373-88.
17)Amarapurkar DN, Patel ND, Rane PS. Diagnosis of Crohn’s disease in India where tuberculosis is widely prevalent. World J Gastroenterol 2008;14:741-6.
18)Lee MJ, Cresswell FV, John L, et al. Diagnosis and treatment strategies of tuberculous intestinal perforations: a case series. Eur J Gastroenterol Hepatol 2012;24: 594-99.
19)Jung Y, Hwangbo Y, Manyoon S, et al. Predictive factors for differentiating between Crohn`s disease and intestinal tuberculosis in koreans. Am J Gastroenterol 2016;111:1156-1164.
20)Franco-Paredes C, Diaz-Borjon A, Senger MA, et al. The ever-expanding association between rheumatologic diseases and tuberculosis. Am J Med 2006;119:470-7.
21)Mukhopadhyay A, Dey R, Bhattacharya U. Abdominal tuberculosis with an acute abdomen: our clinical experience. J Clin Diagn Res 2014; 8: NC07–9.
22)Dasgupta A, Singh N, Bhatia A. Abdominal tuberculosis: a histopathological study with special reference to intestinal perforation and mesenteric vasculopathy. J Lab Physicians 2009; 1: 56–61.
23)Kim SH, Kim JW, Jeong JB, et al. Differential diagnosis of Crohn’s disease and intestinal tuberculosis in patients with spontaneous small-bowel perforation. Dig Surg 2014; 31: 151–6.
24)Zabana Y, Domènech E, San Román AL, et al. Tuberculous chemoprophylaxis requirements and safety in inflammatory bowel disease patients prior to anti-TNF therapy. Inflamm Bowel Dis. 2008;14:1387---91.
25)Taxonera C, Ponferrada A, Gisbert JP, et al. Performance of tuberculin skin test in routine screening for latent tuberculosis infection in patients with inflammatory bowel diseases. J Crohns Colitis. 2015;9:197-8.
26)Pai M, Zwerling A, Menzies D. Sistematic review: T-cell based assaysnfor the diagnosis of latent tuberculosis infection: an update. Ann Intern Med 2008;149:177-84.
27)Li Y, Zhang LF, Liu XQ et al. The role of in vitro interferonγ-release assay in differentiating intestinal tuberculosis from Crohn’s disease in China. J Crohns Colitis 2012; 6: 317–23.
28)Lei Y, Yi FM, Zhao J et al. Utility of in vitro interferon-γ reléase assay in differential diagnosis between intestinal tuberculosis and Crohn’s disease. J Dig Dis 2013; 14: 68–75.
29)Papay P, Eser A, Winkler S, et al. Factors impacting the results of interferon-gamma release assay and tuberculin skin test in routine screening for latent tuberculosis in patients with inflammatory bowel diseases. Inflamm Bowel Dis. 2011;17:84-90.
30)Wong SH, Ip M, Tang W, et al. Performance of interferon-gamma release assay for tuberculosis screening in inflammatory bowel disease patients. Inflamm Bowel Dis. 2014;20:2067---72.
31)Zumla A, Raviglione M, Hafner R, et al. Current concepts: Tuberculosis. N Engl J Med 2013;368:745-55.7e20.
32)Arias-Guillén M, Riestra S, de Francisco R, et al. T-cell profiling and the immunodiagnosis of latent tuberculosis infection in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2014;20:329---38
33)Ye BD, Yang SK, Kim D et al. Diagnostic sensitivity of culture and drug resistance patterns in Korean patients with intestinal tuberculosis. Int J Tuberc Lung Dis 2012;16:799-804.
34)Ramadass B, Chittaranjan S, Subramanian V, Ramakrishna BS. Fecal polymerase chain reaction for Mycobacterium tuberculosis IS6110 to distinguish Crohn’s disease from intestinal tuberculosis. Indian J Gastroenterol 2010; 29: 152–6.
35)Gan HT, Chen YQ, Ouyang Q, Bu H, Yang XY. Differentiation between intestinal tuberculosis and Crohn’s disease in endoscopic biopsy specimens by polymerase chain reaction. Am J Gastroenterol 2002; 97: 1446–51.
36)Jin T, Fei B, Zhang Y et al. The diagnostic value of polymerase chain reaction for Mycobacterium tuberculosis to distinguish intestinal tuberculosis from Crohn`s disease: a meta-analysis. Saudi J Gastroenterol 2017;23:3-10.
37)Ng SC, Hirai HW, Tsoi KK et al. Systematic review with metaanalysis: accuracy of interferon-gamma releasing assay and anti-Saccharomyces cerevisiae antibody in differentiating intestinal tuberculosis from Crohn’s disease in Asians. J Gastroenterol Hepatol 2014; 29: 1664–70.
38)Makharia GK, Sachdev V, Gupta R, Lal S, Pandey RM. Anti- Saccharomyces cerevisiae antibody does not differentiate between Crohn’s disease and intestinal tuberculosis. Dig Dis Sci 2007; 52: 33–9.
39)Kim YS, Kim YH, Kim WH et al. Diagnostic utility of anti- Saccharomyces cerevisiae antibody (ASCA) and interferon-γ assay in the differential diagnosis of Crohn’s disease and intestinal tuberculosis. Clin Chim Acta 2011; 412: 1527–32.
40)Caprilli R, Frieri G. The dyspeptic macrophage 30 years later: an update in the pathogenesis of Crohn’s disease. Dig Liver Dis 2009; 41: 166–8.
41) Makharia GK, Srivastava S, Das P, et al. Clinical, endoscopic, and histological differentiations between Crohn’s disease and intestinal tuberculosis. Am J Gastroenterol 2010;105:642-651.
42)Uzunkoy A, Harma M. Diagnosis of abdominal tuberculosis: experience from 11 cases and review of the literatura. World J Gastroenterol 2004; 10:3647-3649.
43)Du J, Ma YY, Xiang H, Li YM. Confluent granulomas and ulcers lined by epithelioid histiocytes: new ideal method for differentiation of ITB and CD? A meta analysis. PLoS One 2014; 9: e103303.
44)Banerjee R, Balaji M, Sasikala M, Anuradha S, Rao GV, Nageshwar Reddy D. Granulomas of intestinal tuberculosis and Crohn’s disease can be differentiated by CD73 cell surface marker expression: a pilot study. Dig Dis Sci 2013; 58: 2301–7.
45)Yu H, Liu Y, Wang Y, Peng L, Li A, Zhang Y. Clinical, endoscopic and histological differentiations between Crohn’s disease and intestinal tuberculosis. Digestion 2012;85:202-209.
46)Zhao XS, Wang ZT, Wu ZY et al. Differentation of Crohn’s disease from intestinal tuberculosis by clinical and CT enterographic models. Inflamm Bowel Dis 2014;20:916-25.
47)Park YH, Chung WS, Lim JS et al. Diagnostic role of computed tomographic enterography differentiating Crohn disease from intestinal tberculosis. J Comput Assist Tomogr 2013;37:834-839.
48)Ho Bae J, Hyoung Park S, Duk Ye B, et al. Development and validation of a novel prediction model for differential diagnosis between Crohn´s disease and intestinal tuberculosis. Inflamm Bowel Dis 2017;23:1614-1623.
49)Critchley JA, Young F, Orton L, Garner P. Corticosteroids for prevention of mortality in people with tuberculosis: a systematic review and meta-analysis. Lancet Infect Dis 2013;13:223-37.
50)Pratap Mouli V, Munot K, Ananthankirshnan A, Kedia S, Addagalla S, Garg SK et al. Endoscopic and clinical responses to anti-tubercular therapy can differentiate intestinal tuberculosis from Crohn`s disease. Aliment Pharmacol Ther 2017;45:27-37.
Related articles

Letter

Treatment with hyperbaric oxygen in a Crohn’s disease patient

DOI: 10.17235/reed.2024.10166/2023

Letter

Lung abscess in a non-compliant patient with Crohn’s disease

DOI: 10.17235/reed.2024.10140/2023

Letter

Coincidental oral lesions in Crohn’s disease

DOI: 10.17235/reed.2023.9992/2023

Letter

Duodenal stenosis surgical treatment in Crohn’s disease

DOI: 10.17235/reed.2023.9521/2023

Digestive Diseases Image

Peristomal cutaneous Crohn's disease by contiguity

DOI: 10.17235/reed.2022.8909/2022

Letter

Sigmoid colon Schwannoma simulating colon cancer

DOI: 10.17235/reed.2022.8684/2022

Letter

Anal neoplasia and perianal Crohn’s disease: myth or reality?

DOI: 10.17235/reed.2021.8317/2021

Letter

Crohn’s disease in patients treated with etanercept

DOI: 10.17235/reed.2019.6554/2019

Letter to the Editor

Sternal cutaneous metastasis of hilar cholangiocarcinoma

DOI: 10.17235/reed.2017.4979/2017

Original

Mercaptopurine and inflammatory bowel disease: the other thiopurine

DOI: 10.17235/reed.2016.4546/2016

Letter to the Editor

Adnexal localization of Crohn’s disease and recurrent massive ovary cysts

DOI: 10.17235/reed.2016.4301/2016

Case Report

Metastatic Crohn’s disease in pediatrics

DOI: 10.17235/reed.2016.3948/2015

Letter to the Editor

Crohn’s disease and Sweet’s syndrome: A debut together

DOI: 10.17235/reed.2015.3842/2015

Case Report

Ovarian involvement in Crohn´s disease: A rare complication

DOI: 10.17235/reed.2015.3764/2015

Citation tools
Merino Gallego E, Gallardo Sánchez F, Gallego Rojo F. Intestinal tuberculosis and Crohn’s disease: the importance and difficulty of a differential diagnosis. 5184/2017


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 2653 visits.
This article has been downloaded 970 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 22/07/2017

Accepted: 11/03/2018

Online First: 31/08/2018

Published: 01/10/2018

Article revision time: 229 days

Article Online First time: 405 days

Article editing time: 436 days


Share
This article has been rated by 4 readers.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2024 y Creative Commons. The Spanish Journal of Gastroenterology