Intestinal tuberculosis or Crohn's disease: Illusion or delusion or allusion

• Published in: JGH open 2021-02, Vol.5 (2), p.177-179
• Main Authors: Kedia, Saurabh, Ahuja, Vineet
• Format: Article
• Language: English
• Subjects: 20th century; Algorithms; Big Data; Crohn's disease; Etiology; Industrial Revolution; Inflammatory bowel disease; Lymphatic system; Sarcoidosis; Tuberculosis
• ISSN: 2397-9070; 2397-9070
• DOI: 10.1002/jgh3.12495

Over the last two decades, there have been several efforts by gastroenterologists to decipher the dilemma of CD and intestinal TB (ITB), and considerable progress has been made toward dissecting this diagnostic conundrum, but a perfect solution still remains. 14–16 The problem persists primarily due to two reasons: poor sensitivity of definite diagnostic tests for ITB (because of paucibacillary disease) and nonspecific diagnostic criteria for CD. 17 The microbiological (positive stain for acid‐fast bacillus or culture for mycobacterium TB or positive Gene‐Xpert) or pathological tests (caseation granuloma) do have 100% specificity but are limited by poor sensitivity. 18–20 The present study by Israrahmed et al. is another laudable effort in this direction. 21 The authors propose a computed tomography (CT)‐based diagnostic algorithm for differentiating CD from ITB based on their findings on CT enteroclysis/enterography in a cohort of 61 patients with ITB and 24 patients with CD. [...]the most important step toward bridging this gap should involve a holistic effort (across involved specialties) targeting the root, that is, its paucibacillary nature. [...]the follow‐up algorithm proposed earlier and endorsed by guidelines 32,33 requires a revisit with early (at 2–3 months of ATT) objective evaluation and possible shortening of ATT duration in patients with a higher suspicion of CD. TB reactivation is a major concern with anti‐TNF use, and the local TB burden has been identified as a major risk factor for this association, 34 with the highest rates of reactivation being reported from high TB burden countries such as India. 35,36 TB that develops after anti‐TNF therapy can be extrapulmonary in up to 50% and can also involve the intestine. [...]the clinicians in these areas need to be aware of this emerging perplexity of “TB on CD,” which has further enhanced the diagnostic confusion with regard to “TB or CD”.