Endoscopic and clinical responses to anti-tubercular therapy can differentiate intestinal tuberculosis from Crohn's disease

V. Pratap Mouli, K. Munot, A. Ananthakrishnan, S. Kedia, S. Addagalla, S. K. Garg, J. Benjamin, V. Singla, R. Dhingra, V. Tiwari, S. Bopanna, Susan Hutfless, G. Makharia, V. Ahuja

Research output: Contribution to journalArticle

Abstract

Background: Differentiation between intestinal tuberculosis and Crohn's disease is difficult and may require therapeutic trial with anti-tubercular therapy in tuberculosis-endemic regions. Aim: To evaluate the role of therapeutic trial with anti-tubercular therapy in patients with diagnostic confusion between intestinal tuberculosis and Crohn's disease. Methods: We performed retrospective-comparative (n = 288: 131 patients who received anti-tubercular therapy before being diagnosed as Crohn's disease and 157 intestinal tuberculosis patients) and prospective-validation study (n = 55 patients with diagnostic confusion of intestinal tuberculosis/Crohn's disease). Outcomes assessed were global symptomatic response and endoscopic mucosal healing. Results: In the derivation cohort, among those eventually diagnosed as Crohn's disease, global symptomatic response with anti-tubercular therapy was seen in 38% at 3 months and in 37% who completed 6 months of anti-tubercular therapy. Ninety-four per cent of intestinal tuberculosis patients showed global symptomatic response by 3 months. Endoscopic mucosal healing was seen in only 5% of patients with Crohn's disease compared with 100% of intestinal tuberculosis patients. In the validation cohort, all the patients with intestinal tuberculosis had symptomatic response and endoscopic mucosal healing after 6 months of anti-tubercular therapy. Among the patients with an eventual diagnosis of Crohn's disease, symptomatic response was seen in 64% at 2 months and in 31% who completed 6 months of anti-tubercular therapy, none had mucosal healing. Conclusions: Disproportionately lower mucosal healing rate despite an overall symptom response with 6 months of anti-tubercular therapy in patients with Crohn's disease suggests a need for repeat colonoscopy for diagnosing Crohn's disease. Patients with intestinal tuberculosis showing significant symptomatic response after 2–3 months of anti-tubercular therapy, suggest that symptom persistence after a therapeutic trial of 3 months of anti-tubercular therapy may indicate the diagnosis of Crohn's disease.

Original languageEnglish (US)
Pages (from-to)27-36
Number of pages10
JournalAlimentary Pharmacology and Therapeutics
Volume45
Issue number1
DOIs
StatePublished - Jan 1 2017

ASJC Scopus subject areas

  • Pharmacology (medical)

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    Pratap Mouli, V., Munot, K., Ananthakrishnan, A., Kedia, S., Addagalla, S., Garg, S. K., Benjamin, J., Singla, V., Dhingra, R., Tiwari, V., Bopanna, S., Hutfless, S., Makharia, G., & Ahuja, V. (2017). Endoscopic and clinical responses to anti-tubercular therapy can differentiate intestinal tuberculosis from Crohn's disease. Alimentary Pharmacology and Therapeutics, 45(1), 27-36. https://doi.org/10.1111/apt.13840