Confluent granulomas and ulcers lined by epithelioid histiocytes: new ideal method for differentiation of ITB and CD? A meta analysis.

Juan Du,Yan-Yan Ma,You-Ming Li,Ha Xiang,John Green

doi:10.1371/journal.pone.0103303

Juan Du, Yan-Yan Ma + Show 3 more

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https://doi.org/10.1371/journal.pone.0103303

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Journal: PloS one	Publication Date: Oct 9, 2014
Citations: 30	License type: CC BY 4.0

Affiliation: First Affiliated Hospital Zhejiang University

Abstract

BackgroundThere are few widely accepted criteria other than caseation, which has low sensitivity, for differentiating intestinal tuberculosis (ITB) and Crohn's disease (CD).ObjectiveWe performed a meta-analysis to evaluate the use of confluent granulomas and ulcers lined by epithelioid histiocytes as histological methods for differentiating ITB and CD, compared with that of caseation.MethodsWe searched PubMed, Medline, Embase, Web of Science, the Cochrane Library and Chinese Biomedicine Database for all relevant studies on the histological differentiation of ITB and CD. Sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated for each study. Study quality and heterogeneity were assessed. Meta-regression analysis and sensitivity analyses were performed.ResultsTen randomized trials involving 316 ITB and 376 CD patients were included. The results showed that analysis of caseation showed an overall weighted area under the curve (AUC) of 0.9966, overall sensitivity and specificity were 0.21 and 1.00, respectively, with a positive likelihood ratio (+LR) of 10.79, negative likelihood ratio(-LR) of 0.82 and DOR of 13.74. Confluent granulomas had a lower overall weighted AUC of 0.9381, sensitivity and specificity were 0.38 and 0.99, respectively, with a +LR of 16.29, -LR of 0.65 and DOR of 26.52. Overall weighted AUC for ulcers lined by epithelioid histiocytes was 0.9017, sensitivity and specificity were 0.41 and 0.94, respectively, with a +LR of 6.46, -LR of 0.54 and DOR of 13.17. Significant heterogeneity was noted for the studies. Meta-regression analysis showed that study source, publication year, size, design and quality did not affect heterogeneity.ConclusionConfluent granulomas and ulcers lined by epithelioid histiocytes are helpful in distinguishing ITB from CD, which may provide a new method, other than caseating granulomas and acid-fast bacilli, to differentiate ITB and CD in mucosal biopsies.

Highlights

Confluent granulomas and ulcers lined by epithelioid histiocytes are helpful in distinguishing intestinal tuberculosis (ITB) from Crohn’s disease (CD), which may provide a new method, other than caseating granulomas and acid-fast bacilli, to differentiate ITB and CD in mucosal biopsies
Crohn’s disease (CD) is a multifactorial inflammatory bowel disease (IBD), which results in idiopathic chronic inflammation in the gastrointestinal (GI) tract
In the Chinese studies, diagnosis was according to the suggested guidelines for the diagnosis and treatment of inflammatory bowel disease (IBD), which were approved in China in 2001 [8] or the Consensus on the management of inflammatory bowel disease in China in 2007 [9]

Summary

Introduction

Crohn’s disease (CD) is a multifactorial inflammatory bowel disease (IBD), which results in idiopathic chronic inflammation in the gastrointestinal (GI) tract. Intestinal tuberculosis (ITB) is caused by Mycobacterium tuberculosis, and is often seen secondary to pulmonary tuberculosis. ITB and CD are both chronic granulomatous disorders with similar clinical presentation, morphology and pathology. They share many common immune pathways of pathogenesis, which includes, triggering potent adaptive TH1 cytokine responses resulting in granuloma formation [5]. The differentiation between ITB and CD is very important, as the treatment of each diseas is different. There are few widely accepted criteria other than caseation, which has low sensitivity, for differentiating intestinal tuberculosis (ITB) and Crohn’s disease (CD)

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Conclusion