P169. Comparison of Crohn's disease and intestinal tuberculosis by clinical, laboratory, endoscopic, radiologic and histologic parameters
I. Hatemi1, Y. Erzin1, K. Kochan2, G. Aygun3, G. Dogusoy4, S. Erdamar4, B. Baca5, A.F. Celik1
1Istanbul University Cerrahpasa Medical Faculty, Gastroenterology, Istanbul, Turkey; 2Istanbul University Cerrahpasa Medical Faculty/Department of Internal Medicine, Istanbul, Turkey; 3Istanbul University Cerrahpasa Medical faculty, Microbiology, Istanbul, Turkey; 4Istanbul University Cerrahpasa Medical Faculty, Pathology, Turkey; 5Istanbul University Cerrahpasa Medical Faculty, Surgery, Istanbul, Turkey
Background: In this retrospective study, to we compared clinical, laboratory, endoscopic and histologic findings of patients with Crohn's disease (CD) and gastrointestinal tuberculosis (GI-TB).
Methods: Between December 1999 and September 2011, 20 patients have been diagnosed as GI-TB and 537 cases as CD. GI-TB was diagnosed either by stool cultures (n = 10) or endoscopic biopsy specimen cultures (n = 10) which were M.tuberculosis. All GI-TB cases were also confirmed by post treatment colonoscopies. We selected 40 CD patients for comparison, by including the patient before and after each GI-TB on the registration list. We surveyed the charts and compared the clinical, endoscopic, radiologic and histological findings of CD and GI-TB patients.
Results: Gastrointestinal symptoms were similiar in the two groups as well as endoscopic and radiological findings. Although all patients presented with prominent intestinal symptoms, and diagnosed initially as GI-TB, radiologic examination revealed some findings of pulmonary tuberculosis in 45% (9/20) of the patients. Six of them had caverns and 3 had paranchimal infiltrations in the chest CT's. This has not been proved in none of the CD cases. In a binary logistic regression model we found that fever, perforation, granuloma and high CRP levels were important to distinguish GI-TB from CD (Tables 1,2).
| Clinical Features | CD (N = 40) | GI-TB (N = 20) | P |
|---|---|---|---|
| Age | 37.1±11.5 | 35.5±12.2 | 0.64 |
| Fever (≥37.5°C) | 6/40 | 11/20 | 0.002 |
| Weight Loss | 13/40 | 17/20 | <0.001 |
| Diarrhea | 29/40 | 14/20 | 1 |
| Perinal fistula | 10/40 | 0/20 | 0.02 |
| Perforation | 0/40 | 4/20 | 0.009 |
| Arthralgia/Arthritis | 21/40 | 2/20 | 0.001 |
| PPD positivity (>5 mm) | 13/40 | 11/20 | 0.1 |
| Granuloma (non-caseating) | 4/40 | 13/20 | <0.001 |
| Endoscopic findings | |||
|---|---|---|---|
| Stricture | 15/40 | 3/20 | 0.1 |
| Deep ulcer | 7/40 | 5/20 | 0.1 |
| Ileocecal involvement | 23/40 | 11/20 | 0.4 |
| Radiological findings | |||
| Increased bowel wall (≥1cm) | 27/40 | 15/20 | 0.5 |
| Intraabdominal lymph node | 16/40 | 15/20 | 0.01 |
| Biochemical findings | |||
| CRP | 34.4±48.2 | 96.3±50.7 | <0.001 |
| Anemia | 25/40 | 18/20 | 0.03 |
Conclusions: GI-TB is indistinguishable from CD regarding endoscopic and radiological findings. Nearly half of GI-TB patients may also have pulmonary Tb in a country with a high TB prevalence. Suspicion of GI-TB with or without pulmonary symptoms may rationalise the thorax CT examination before begining immunsuppresive therapy. In contrast to common belief, non-caseating granuloma in endoscopic mucosal biopsies are more suggestive of GI-TB (85%) rather than CD (10%).