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P139 Predictive Factors for Differentiating between Crohn's disease and Intestinal tuberculosis in Korea

Y. Jung*1, K.C. Huh2, S.M. Yoon3, H.S. Koo2, H.D. Shin4, J.E. Shin4, H.S. Moon5, S.B. Kang6, J.R. Lee7, H. Young8

1Soonchunhyang University College of Medicine, Department of Internal Medicine, Cheonan-si, Korea, Republic of, 2Konyang University College of Medicine, Department of Internal Medicine, Daejeon, Korea, Republic of, 3Chungbuk National University College of Medicine, Internal Medicine, Cheongju, Korea, Republic of, 4Dankook University College of Medicine, Internal medicine, Cheonan, Korea, Republic of, 5Chungnam National University Hospital, Department of Internal Medicine, Daejeon, Korea, Department of Internal Medicine, Daejeon, Korea, Republic of, 6St. Mary's Hospital, College of Medicine, Department of Internal Medicine, Daejeon, Korea, Republic of, 7Konkuk University of Medicine, Department of Internal Medicine, Chungju, Korea, Republic of, 8Soonchunhyang University College of Medicine, Department of Preventive medicine, Cheonan-si, Korea, Republic of

Background

A differential diagnosis of intestinal tuberculosis (ITB) from Crohn's disease (CD) is still challenging and a delayed diagnosis or misdiagnosis has sometimes a big impact on prognosis. The aim of this study was to investigate the value of clinical, endoscopic and histological features which may be helpful in distinguishing between CD and ITB.

Methods

261 patients, 99 patients with conformed diagnosis of ITB and 162 patients with CD, were recruited from 2005 to 2013 in 7 tertiary centers and reviewed retrospectively. Their clinical, laboratory, endoscopic, and pathologic feature were analyzed.

Results

The clinical feature of age (CD: 28 ± 13 vs ITB: 50 ± 17, P<0.001), sex (CD; M: 70.4%, F: 29.6% vs ITB M: 38.4%, F: 61.6%, P<0.001), hypertension (CD: 2.5% vs ITB: 14.1%, P<0.001), abdominal pain (CD: 82.7% vs ITB: 60.6%, P<0.001), diarrhea (CD: 67.9% vs ITB: 20.2%, P<0.001), hematochezia (CD: 29.6% vs ITB: 14.1%, P=0.004), fever (CD: 24.7% vs ITB: 13.3%, P=0.003), weight loss (CD: 32.1% vs ITB: 15.2%, P=0.002), and perianal disease (CD: 32.1% vs ITB: 0%, <0.001) were significantly difference between both groups. The laboratory feature of platelet (CD: 379.2 x 103 vs Tb: 295.3 x 103/mm3, P<0.001) (CD: 355.2 x 103 vs Tb: 283.1 x 103, P<0.01), ESR (CD: 46.8 ± 33 vs TB: 30.6 ± 27, <0.001) and Quantiferon TB gold test (CD: 9.3% vs ITB: 75.7%, <0.001) were significantly difference between both group. The endoscopic feature of aphthous ulcer (CD: 59.9% vs ITB: 21.2%, P<0.001), ring shape ulcer (CD: 14.2% vs ITB: 71.7%, P<0.001), longitudinal ulcer (CD: 63.0% vs ITB: 7.0%, P<0.001), cobble stone appearance (CD: 40.1% vs ITB: 10.1%, P<0.001), scar change (CD: 16.7% vs ITB: 30.3%, P=0.01), stricture (CD: 27.8% vs ITB: 9.1%, P<0.001), and fistula (CD: 19.4% vs ITB: 0.0%, P<0.001) were significantly difference between both group. The sites of intestinal involvement (CD: 3.4 ± 2.3 vs ITB: 2.2 ± 1.6, P<0.001) were significant larger in CD and transverse, descending, sigmoid, and rectal involvement were more frequent in CD. The pathologic feature of caseous necrosis in granuloma was significantly more frequent in Tb (P<0.001). However, cryptitis and crypt abscess were no significant difference between two groups. On multivariate analysis, ring shape ulcer (odds ratio (OR) 29.1 (confidence interval (CI) 6.29-135.2), P<0.001) was predictor of ITB. Abdominal pain (OR 4.6 (CI 1.0-21.4), p=0.05), diarrhea (OR 6.8 (CI 1.0-21.4), p=0.004), aphthous ulcer (OR 7.6 (CI 1.8-33.4), p=0.008), and longitudinal ulcer were predictors of CD.

Conclusion

Abdominal pain, diarrhea, aphthous ulcer, and longitudinal ulcer were the most important features in differentiating CD from ITB.