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Systematic review with meta‐analysis: Accuracy of interferon‐gamma releasing assay and anti‐ S accharomyces cerevisiae antibody in differentiating intestinal tuberculosis from C rohn's disease in A sians
Author(s) -
Ng Siew C,
Hirai Hoyee W,
Tsoi Kelvin K F,
Wong Sunny H,
Chan Francis K L,
Sung Joseph J Y,
Wu Justin C Y
Publication year - 2014
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12645
Subject(s) - medicine , likelihood ratios in diagnostic testing , confidence interval , quantiferon , meta analysis , tuberculosis , interferon gamma release assay , gastroenterology , gold standard (test) , area under the curve , antibody , latent tuberculosis , immunology , mycobacterium tuberculosis , pathology
Background and Aims Distinguishing C rohn's disease ( CD ) from intestinal tuberculosis ( ITB ) is a clinical challenge. This meta‐analysis assessed the clinical usefulness of Interferon‐gamma releasing assay ( IGRA ) and anti‐ S accharomyces cerevisiae antibody ( ASCA ) in the diagnosis of ITB and CD , respectively. Methods Systematic search without language restriction was conducted in AMED , EBM , MEDLINE , EMBASE , and G oogle S cholar until S eptember 2013. Studies that have evaluated performance of IGRA ( QuantiFERON ‐ TB G old or T ‐ SPOT . TB ) or ASCA in distinguishing ITB from CD were eligible. Main outcome measures included sensitivity and specificity. Random‐effects models were used to combine estimates from studies with significant heterogeneity. Area under the curve ( AUC ) was used to measure accuracy of the tests. Results Eleven studies (five IGRA , three ASCA , three IGRA and ASCA ) involving 1081 subjects were included. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of IGRA for the diagnosis of ITB was 81% (95% CI , 75–86%), 85% (95% CI , 81–89%), 6.02 (95% CI : 4.62–7.83), and 0.19 (95% CI : 0.10–0.36), respectively. The AUC was 0.92. The pooled sensitivity and specificity of ASCA for the diagnosis of CD was 33% (95% confidence interval [ CI ], 27%–38%) and 83% (95% CI , 77–88%), respectively with an AUC of 0.58. T‐ SPOT . TB showed a higher sensitivity than Q uanti FERON ‐ TB G old for the diagnosis of ITB . Conclusions IGRA and ASCA have a high specificity for the diagnosis of ITB . Both IGRA and ASCA may have a supplementary role in the differential diagnosis between ITB and CD when conventional workup is not diagnostic.