Qing Gu1, Qin Ouyang, Wen-Yan Zhang, Gan-di Li. 1. Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China. gumingsiyi@sohu.com
Abstract
OBJECTIVE: To search for the distinctive diagnostic features of Crohn's disease and intestinal tuberculosis in clinical manifestations with methods widely used clinically. METHODS: A retrospective study enrolled 33 Crohn's disease and 34 intestinal tuberculosis inpatients in West China Hospital of Sichuan University from 1996 to 2007. The clinical characteristics and key points of differential diagnosis were analyzed. All the pathological sections were studied again. RESULTS: The total duration of symptoms in patients with a diagnosis of Crohn's disease was longer than that in patients with intestinal tuberculosis (P < 0.05). The incidence of colectomy is significantly higher in Crohn's disease than in intestinal tuberculosis because of intestinal obstruction or undefined diagnosis (P < 0.05). Hematochezia, extra-intestinal manifestation and ileus occurred significantly more in Crohn's disease than in intestinal tuberculosis (P < 0.05). Night sweating and hypoalbuminemia occurred significantly more in intestinal tuberculosis than in Crohn's disease (P < 0.05). The positive rate of serum antibodies to mycobacterium and increased erythrocyte sedimentation rate is higher in intestinal tuberculosis than in Crohn's disease (P < 0.05). Cobblestone sign and fissure-shape ulcers were only found in Crohn's disease, while circular ulcer occurred significantly more in intestinal tuberculosis (P < 0.05). The involvement of stomach, jejunum or ileum was significantly more in Crohn's disease than in intestinal tuberculosis (P < 0.05).Granulomas were more common in intestinal tuberculosis than in Crohn's disease (P < 0.05) and the site of granulomas was valuable for differential diagnosis. In all the Crohn's disease specimens, lymphoid aggregates in the lamina propria or submucosa were significantly more in surgically resected specimens than in endoscopic biopsies (P < 0.05). CONCLUSIONS: There are definitely some different features between the two diseases. It is essential to review the whole clinical data of the patient. The frequency of granulomas and the distribution of chronic inflammation are identified as histological parameters that can be used to differentiate tuberculosis and Crohn's disease.
OBJECTIVE: To search for the distinctive diagnostic features of Crohn's disease and intestinal tuberculosis in clinical manifestations with methods widely used clinically. METHODS: A retrospective study enrolled 33 Crohn's disease and 34 intestinal tuberculosis inpatients in West China Hospital of Sichuan University from 1996 to 2007. The clinical characteristics and key points of differential diagnosis were analyzed. All the pathological sections were studied again. RESULTS: The total duration of symptoms in patients with a diagnosis of Crohn's disease was longer than that in patients with intestinal tuberculosis (P < 0.05). The incidence of colectomy is significantly higher in Crohn's disease than in intestinal tuberculosis because of intestinal obstruction or undefined diagnosis (P < 0.05). Hematochezia, extra-intestinal manifestation and ileus occurred significantly more in Crohn's disease than in intestinal tuberculosis (P < 0.05). Night sweating and hypoalbuminemia occurred significantly more in intestinal tuberculosis than in Crohn's disease (P < 0.05). The positive rate of serum antibodies to mycobacterium and increased erythrocyte sedimentation rate is higher in intestinal tuberculosis than in Crohn's disease (P < 0.05). Cobblestone sign and fissure-shape ulcers were only found in Crohn's disease, while circular ulcer occurred significantly more in intestinal tuberculosis (P < 0.05). The involvement of stomach, jejunum or ileum was significantly more in Crohn's disease than in intestinal tuberculosis (P < 0.05).Granulomas were more common in intestinal tuberculosis than in Crohn's disease (P < 0.05) and the site of granulomas was valuable for differential diagnosis. In all the Crohn's disease specimens, lymphoid aggregates in the lamina propria or submucosa were significantly more in surgically resected specimens than in endoscopic biopsies (P < 0.05). CONCLUSIONS: There are definitely some different features between the two diseases. It is essential to review the whole clinical data of the patient. The frequency of granulomas and the distribution of chronic inflammation are identified as histological parameters that can be used to differentiate tuberculosis and Crohn's disease.
Authors: Julajak Limsrivilai; Andrew B Shreiner; Ananya Pongpaibul; Charlie Laohapand; Rewat Boonanuwat; Nonthalee Pausawasdi; Supot Pongprasobchai; Sathaporn Manatsathit; Peter D R Higgins Journal: Am J Gastroenterol Date: 2017-01-03 Impact factor: 10.864