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P232. How frequent is gastrointestinal tuberculosis in patients with ileocecal inflammation in a tuberculosis prevelant country: Evaluation of 114 consecutive patients in an inflammatory bowel disease clinic of a tertiary referral center

Y. Erzin1, I. Hatemi1, G. Aygun2, S. Erdamar3, A.F. Celik1, 1Istanbul University Cerrahpasa Medical Faculty, Gastroenterology, Istanbul, Turkey, 2Istanbul University Cerrahpasa Medical faculty, Microbiology, Istanbul, Turkey, 3Istanbul University Cerrahpasa Medical Faculty, Pathology, Turkey

Background

Aim of the study was to determine the incidence of gastrointestinal tuberculosis (GI-TB) in consecutive patients with ileocecal inflammation who were referred to a tertiary inflammatory bowel disease (IBD) center in a TB prevalent country.

Methods

Currently we have 638 CD, 1010 UC, 55 GI Behçet's Disease, and 27 GI-TB patients under same registry. Between 2003–2007, 114 patients referred to our IBD clinic with ileocecal involvement were evaluated retrospectively although the data was gathered in a prospective manner. Patients with ileocecal involvement in prior colonoscopies performed elsewhere, or with ileocecal wall thickening, abscess or fistulae formation on CT who, admitted to our department with no definite diagnosis were enrolled into the study protocol. Patients who did not agree to have the second colonoscopy to obtain further biopsies for TB culture were excluded. From each patient four punch biopsies were obtained for microbiological investigations for EZN staining, TB-PCR, and Loewenstein culture and then two more additional biopsies for histopathological examination. Fecal samples for the same microbiological investigations were obtained. When TB was detected in one of the tests a plain radiography and/or CT of the thorax was performed. All the patients with a diagnosis of GI-TB were treated for one year and the colonoscopies were repeated at the end of treatment.

Results

There were five (four men, one woman) GI-TB patients among 114 (4.5%) consecutive patients with ileocecal involvement. Time from the symptom onset to GI-TB diagnosis ranged between 5–12 months. None of them had a prior personal or family history of TB nor pulmonary symptoms but two of them had caverns and one of them had apical infiltration on plain chest x-ray pointing out to active pulmonary TB. The remaining two had normal radiographic findings even in thorax CT. Colonic biopsies were positive for EZN staining in only one (20%) patient, PCR and culture in four (80%. Long term follow-up of the remainder of the group (109 patients) almost a decade let us be sure about our initial diagnosis as none of these patients developed GI-TB even under immunosupressive medications.

Conclusion

In an endemic area for TB the incidence of GI-TB was 4.5% in consecutive patients with ileocecal inflammation and ulcers. However, after paying enough attention to basic clinical considerations and laboratory examinations, challenging cases of GI-TB is less than 2% in an IBD clinic of a TB prevalent country.