Open AccessEndoscopic features and treatment response have better prediction rate than clinical symptoms/signs in distinguishing Crohn's disease and intestinal tuberculosis
Author(s) -
Lin WeiChen,
Chang ChenWang,
Wang TsangEn,
Wang HorngYuan,
Shih ShouChuan,
Chu ChengHsin,
Hsu TzuChi
Publication year - 2017
Publication title -
advances in digestive medicine
Language(s) - English
Resource type - Journals
ISSN - 2351-9800
DOI - 10.1002/aid2.12121
Subject(s) - medicine , hematochezia , gastroenterology , tuberculosis , crohn's disease , abdominal pain , diarrhea , incidence (geometry) , disease , colonoscopy , weight loss , ileocecal valve , surgery , pathology , colorectal cancer , ileum , cancer , physics , optics , obesity
Summary Background Intestinal tuberculosis (ITB) is less common than Crohn's disease (CD) in Taiwan. Despite the worldwide decline in TB incidence over last several years, the prevalence yet remains high. Therefore, there is a necessity to increase the clinical awareness of this serious health problem. The aim of this study was to investigate the value of clinical methods that may be helpful in distinguishing CD from ITB. Methods Eighty‐five patients, 67 and 18 patients diagnosed with CD and ITB, respectively, from January 2000 to April 2015 at Mackay Memorial Hospital, Taipei were included. The clinical, laboratory, endoscopic, and histological characteristics were reviewed retrospectively. Results CD patients (33 ± 13 years) were younger than ITB patients (57 ± 21 years) ( p = 0.103). The incidences of hematochezia, abdominal pain, diarrhea, fever, and weight loss were not significantly different ( p = 0.388, p = 0.699, p = 0.751, p = 0.468, and p = 0.611, respectively). The hemoglobin, platelet, and C‐reactive protein (CRP) levels were also not significantly different ( p = 0.388, p = 0.440, and p = 0.330, respectively). The endoscopic features of aphthous ulcer and cobblestone appearance were seen more often in CD patients ( p = 0.043 and p = 0.010, respectively). Rectal lesions (29.9 vs. 0%; p = 0.020) were seen only in CD patients. Patulous ileocecal valve was specifically seen in ITB patients ( p = 0.006). The histological features of granuloma, cryptitis and crypt abscess, and fissure formation were not significantly different ( p = 0.377, p = 0.293, and p = 0.212, respectively). Conclusions The endoscopic features of aphthous ulcerations, cobblestone appearance, and rectal involvement in CD and of patulous ileocecal valve in ITB, along with clinical treatment follow‐up, tend to be useful diagnostic characteristics differentiating CD and ITB. Copyright © 2017, The Gastroenterological Society of Taiwan, The Digestive Endoscopy Society of Taiwan and Taiwan Association for the Study of the Liver.