https://www.spg.pt/wp-content/uploads/2015/11/2013-JCC_ECCO_Endoscopy_Consensus_10_2013_inPress.pdf

European evidence based consensus for endoscopy in inflammatory bowel disease

Clinical, endoscopic, and histological differentiations between Crohn's disease and intestinal tuberculosis.

Differentiating intestinal tuberculosis from Crohn's disease (CD) is an important clinical challenge of considerable therapeutic significance. The problem is of greatest magnitude in countries where tuberculosis continues to be highly prevalent, and where the incidence of CD is increasing. The final clinical diagnosis is based on a combination of the clinical history with endoscopic studies, culture and polymerase chain reaction for Mycobacterium tuberculosis, biopsy pathology, radiological investigations and response to therapy. In a subset of patients, surgery is required and intraoperative findings with pathological study of the resected bowel provide a definitive diagnosis. Awareness of the parameters useful in distinguishing these two disorders in each of the different diagnostic modalities is crucial to accurate decision making. Newer techniques, such as capsule endoscopy, small bowel enteroscopy and immunological assays for Mycobacterium tuberculosis, have a role to play in the differentiation of intestinal tuberculosis and CD. This review presents currently available evidence regarding the usefulness and limitations of all these different modalities available for the evaluation of these two disorders.

Differentiation of Crohn's disease from intestinal tuberculosis in India in 2010.

Differentiating intestinal tuberculosis from Crohn’s disease
(CD) is an important clinical challenge of considerable
therapeutic significance. The problem is of greatest
magnitude in countries where tuberculosis continues to
be highly prevalent, and where the incidence of CD is increasing. The final clinical diagnosis is based on a combination of the clinical history with endoscopic studies, culture and polymerase chain reaction for Mycobacterium tuberculosis , biopsy pathology, radiological investigations and response to therapy. In a subset of patients, surgery is required and intraoperative findings with pathological study of the resected bowel provide a definitive diagnosis. Awareness of the parameters useful in distinguishing these two disorders in each of the different diagnostic modalities is crucial to accurate decision making. Newer techniques, such as capsule endoscopy, small bowel enteroscopy and immunological assays for Mycobacterium
tuberculosis , have a role to play in the differentiation of
intestinal tuberculosis and CD. This review presents currently available evidence regarding the usefulness and
limitations of all these different modalities available for
the evaluation of these two disorders.

Differentiation of Crohn’s disease from intestinaltuberculosis in India in 2010

Although Crohn's disease is thought to be rare and intestinal tuberculosis common in India, Crohn's disease is being reported more often. However, there is a lack of systematic study on Crohn's disease from India. In this analysis of data from three inflammatory bowel disease clinics (two in northern India and one in eastern India), criteria for Crohn's disease were applied retrospectively: (1) World Health Organization (WHO) criteria; or (2) compatible histology (European Crohn's and Colitis Organization) or failure of response to 4-8 weeks of anti-tuberculosis therapy (Asia-Pacific guidelines); or (3) compatible macroscopic, radiologic, colonoscopic features (European Crohn's and Colitis Organization). Others were classified as probable Crohn's disease. The Montreal classification was used for disease phenotype. Age at onset and duration of symptoms (182 patients, 117 male) were 34.5 (+/-13.6; 7-73) years and 3.0 (+/-5.8; 0.1-36) years, respectively. Diarrhea (68%), abdominal pain (62%), and weight loss (57%) were common. The common intestinal complications were occult (27%) and overt (40%) gastrointestinal bleeding and obstruction (28%). There were 141 (78%) and 41 (22%) with definite and probable Crohn's disease respectively. Of 147 (81%) available histopathology specimens (endoscopic biopsy in 110; 75%), 31 (21%) had granuloma. Seventy-one out of 166 (43%) had received anti-tuberculosis therapy in the past. Results from the Montreal classification were as follows: age at onset, A1:A2:A3 6%:64%:30%; location of disease, L1:L2:L3:L4 32%:41%:23%:4%, and disease behavior, B1:B2:B3 51%:24%:25%. Twenty-six (15%) and 31 (17%) patients had upper gastrointestinal and perianal modifiers. The drugs used were: aminosalicylates (128, 70%), steroids (76, 42%), azathioprine (53, 29%), methotrexate (4, 2%), and salazopyrine (14, 8%). Sixty-six (36%) patients underwent surgical treatment. We concluded that the phenotype of Crohn's disease in India is very similar to that described in other regions of Asia and the West, except for a delay in diagnosis and a more complicated disease at diagnosis.

Crohn’s Disease in India: A Multicenter Study from a Country Where Tuberculosis Is Endemic

Summary


Background Distinguishing Crohn’s disease from intestinal tuberculosis in endemic areas is challenging as both conditions have overlapping clinical, radiological, endoscopic and histological characteristics Furthermore, high rates of latent tuberculosis confer a considerable risk of reactivation once therapy for established Crohn’s disease is started



Aim  To review current strategies in differentiating these two conditions, and in managing Crohn’s disease, in populations with high rates of tuberculosis



Methods  Literature review and clinical experience



Results  While various clinical, radiological, endoscopic and histological parameters may aid in differentiating Crohn’s disease from intestinal tuberculosis, these remain imperfect and as treatment options differ misdiagnosis has grave consequences We propose a diagnostic algorithm, based on currently available evidence and experience, to aid in this dilemma We also discuss approaches to the management of Crohn’s disease, including agents targeting tumour necrosis factor-α, in patients at risk of developing tuberculosis



Conclusions  A diagnosis of Crohn’s disease in individuals at risk for tuberculosis should only be made after careful interpretation of clinical signs, abdominal imaging and systematic endoscopic and histological assessment Newer techniques for the diagnosis of latent tuberculosis still need to be validated in this environment, and guidelines on the treatment of latent tuberculosis in this setting require clarification

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2036.2007.03332.x

Review article: the diagnosis and management of Crohn's disease in populations with high-risk rates for tuberculosis.

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Review article: the diagnosis and management of Crohn's disease in populations with high-risk rates for tuberculosis.