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P718 Diagnostic yield of colonoscopic images and biopsy Results by tuberculosis culture (solid and liquid) in patients with intestinal ulceration

M. Basaranoglu*1, 2, O. Coskun3, M. Yuksel3, M. Kaplan2, A. Aksoy2, N. Ucarman4, N. Turhan5, A. Arslantürk4

1Bezmialem University, Gastroenterology, Istanbul, Turkey, 2Türkiye Yuksek Ihtisas Hospital, Gastroenterology, Ankara, Turkey, 3Türkiye Yüksek Ihtisas, Gastroenterology, Ankara, Turkey, 4Türkiye Halk Sagligi, Hifzisihha Instute, Microbiology, Ankara, Turkey, 5Türkiye Yuksek Ihtisas Hospital, Pathology, Ankara, Turkey

Background

Intestinal tuberculosis (TB) disease can be difficult to diagnose because its symptoms and laboratory results are nonspecific. Moreover, endoscopic lesions resemble those of other diseases such as Crohns disease (CD). The aim of this study was to evaluate the diagnostic yield of colonoscopic images and biopsy results by TB culture.

Methods

The medical records of 82 consecutive patient swith intestinal ulceration (colonic, ileal or both) were analyzed. None had active pulmonary tuberculosis. It was reported that the endoscopic findings most characteristic of intestinal TB that are (1) circular ulcers, (2) small diverticula (3-5 mm), and (3) sessile firm polyps were searched. We defined the patients with all 3 criteria as intestinal TB with 100% certanity according to the published literature, with 2 criteria as probable; and with just one criterion as no TB. More importantly, intestinal tissue PCR, liquid and solid TB cultures were performed in each patient.

Results

Of the 82 patients with intestinal ulceration, the endoscopic findings most characteristic for intestinal TB were found in 3 (3.65 %); 13 patients had probable intestinal TB; and the rest (66 patients) had no TB according to the endoscopic imaging findings.

Mycobacterium tuberculosis was isolated from the culture of biopsy specimens in 2 patients (2.43 %). One patient with solid TB culture positive had all 3 endoscopic futures of intestinal TB (circular ulcers, small diverticula (3-5 mm), and sessile firm polyps). Contrary, one patient without any endoscopic futures for TB had PCR (+) and liquid TB culture (+).

PCR (+) were noted in 3 patients (3.65%). Two of them showed no endoscopic futures for intestinal TB, but PCR (+) and negative TB culture.

Mycobacterium culture established the diagnosis of intestinal TB, CORRECTY in 2 (2.43 %) patients.

Of the 82 patients, 4 had previous pulmonary tuberculosis history. One of them showed positive PCR and TB culture. One had only PCR (+). The rest 2 patients had negative PCR and TB culture.

Conclusion

Before getting the result of Mycobacterium culture, the WRONGLY diagnosis could be made by either endoscopic examination or the presence of PCR positivity. Differentiating between intestinal TB and CD is very important since steroid treatment can be life saving in CD and lethal in intestinal TB.