Geir Larsson1, Koticherry Thrivikrama Shenoy2, Ramalingom Ramasubramanian3, Lakshmikanthan Thayumanavan4, Leena Kondarappassery Balakumaran2, Gunnar A Bjune5, Bjørn A Moum6. 1. Unger-Vetlesen Institute, Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway ; Faculty of Medicine, University of Oslo, Norway. 2. Population Health and Research Institute, Medical College, Trivandrum, Kerala, India. 3. Thoothukudi Government Medical College, Tuticorin, Tamil Nadu, India. 4. Government Rajaji Hospital, Madurai, Tamil Nadu, India. 5. Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway. 6. Department of Gastroenterology and Hepatology, Institute of Clinical Medicine, Oslo University Hospital Ullevål, Oslo, Norway.
Abstract
BACKGROUND: Current methods to establish the diagnosis of intestinal tuberculosis are inadequate. OBJECTIVES: We aimed to determine the clinical features of intestinal tuberculosis and evaluate inflammatory biomarkers in intestinal as well as pulmonary tuberculosis. METHODS: We recruited 38 intestinal tuberculosis patients, 119 pulmonary tuberculosis patients and 91 controls with functional gastrointestinal disorders between October 2009 and July 2012 for the investigation of clinical features, C-reactive protein (CRP), faecal and serum calprotectin. Faecal calprotectin ≥200 µg/g was used as a cut-off to determine intestinal inflammation of clinical significance. Three patient categories were established: (a) pulmonary tuberculosis and faecal calprotectin <200 µg/g (isolated pulmonary tuberculosis); (b) pulmonary tuberculosis and faecal calprotectin ≥200 µg/g (combined pulmonary and intestinal tuberculosis); (c) isolated intestinal tuberculosis. RESULTS: Common clinical features of intestinal tuberculosis were abdominal pain, fatigue, weight loss and watery diarrhoea. Intestinal tuberculosis patients had elevated median CRP (10.7 mg/l), faecal calprotectin (320 µg/g) and serum calprotectin (5.7 µg/ml). Complete normalisation of CRP (1.0 mg/L), faecal calprotectin (16 µg/g) and serum calprotectin (1.4 µg/ml)) was seen upon clinical remission. Patients with combined pulmonary and intestinal tuberculosis had the highest levels of CRP (53.8 mg/l) and serum calprotectin (6.5 µg/ml) and presented with signs of more severe disease. CONCLUSION: Calprotectin analysis reveals intestinal tuberculosis in patients with pulmonary tuberculosis and pinpoints those in need of rigorous follow-up.
BACKGROUND: Current methods to establish the diagnosis of intestinal tuberculosis are inadequate. OBJECTIVES: We aimed to determine the clinical features of intestinal tuberculosis and evaluate inflammatory biomarkers in intestinal as well as pulmonary tuberculosis. METHODS: We recruited 38 intestinal tuberculosispatients, 119 pulmonary tuberculosispatients and 91 controls with functional gastrointestinal disorders between October 2009 and July 2012 for the investigation of clinical features, C-reactive protein (CRP), faecal and serum calprotectin. Faecal calprotectin ≥200 µg/g was used as a cut-off to determine intestinal inflammation of clinical significance. Three patient categories were established: (a) pulmonary tuberculosis and faecal calprotectin <200 µg/g (isolated pulmonary tuberculosis); (b) pulmonary tuberculosis and faecal calprotectin ≥200 µg/g (combined pulmonary and intestinal tuberculosis); (c) isolated intestinal tuberculosis. RESULTS: Common clinical features of intestinal tuberculosis were abdominal pain, fatigue, weight loss and watery diarrhoea. Intestinal tuberculosispatients had elevated median CRP (10.7 mg/l), faecal calprotectin (320 µg/g) and serum calprotectin (5.7 µg/ml). Complete normalisation of CRP (1.0 mg/L), faecal calprotectin (16 µg/g) and serum calprotectin (1.4 µg/ml)) was seen upon clinical remission. Patients with combined pulmonary and intestinal tuberculosis had the highest levels of CRP (53.8 mg/l) and serum calprotectin (6.5 µg/ml) and presented with signs of more severe disease. CONCLUSION: Calprotectin analysis reveals intestinal tuberculosis in patients with pulmonary tuberculosis and pinpoints those in need of rigorous follow-up.
Authors: Alain M Schoepfer; Christoph Beglinger; Alex Straumann; Michael Trummler; Stephan R Vavricka; Lukas E Bruegger; Frank Seibold Journal: Am J Gastroenterol Date: 2009-09-15 Impact factor: 10.864