Short Term Colonoscopic Follow Up After Anti-Tuberculous Medication in Patients with Atypical Ulcers on IC Valve and Terminal Ileum

Abstract

Backgrounds/Aim: Atypical ulcers on IC valve and terminal ileum in patients with chronic diarrhea and RLQ pain do not provide confirmative diagnosis between tuberculosis and other inflammatory bowel disease. In Korea, pulmonary and extrapulmonary tuberculosis are not rare. So short term anti-tuberculosis medication is known to be helpful for making differentiation. We analyzed the colonoscopic findings before and after the tuberculosis treatment in patients with intestinal tuberculosis and atypical inflammatory bowel disease. Methods: From March 2002 to October 2004, We analyzed the colonoscopic findings before and after the tuberculosis treatment in 23 patients with intestinal tuberculosis and 25 patients with atypical inflammatory bowel disease. Mean duration for tuberculous medication is 107.3 days. Results: Ulcers are located at IC valve, AC and terminal ielum in both groups. There are no rectal and perianal lesion in both groups. Ulcers show geographic and irregular shape. Aphthous ulcers are common in IBD patients and transverse ulcers are common in intestinal tuberculosis patients (p < 0.05). After tuberculous medication, there are scarring and inflammatory polyps in patients with intestinal tuberculosis, but active ulcers are remained and sometimes aggravated in patients with inflammatory bowel disease (p < 0.05). On follow up, patients with inflammatory bowel disease were diagnosed as Crohn's disease in 13 patients, Bechet's enterocolitis in 8 patients and simple ulcers in 4 patients. Conclusions: In cases of atypical ulcers around IC valve, 3 months of anti-tuberculous treatment and colonoscopic follow up are valuable for making confirmative diagnosis and therapeutic plan. Backgrounds/Aim: Atypical ulcers on IC valve and terminal ileum in patients with chronic diarrhea and RLQ pain do not provide confirmative diagnosis between tuberculosis and other inflammatory bowel disease. In Korea, pulmonary and extrapulmonary tuberculosis are not rare. So short term anti-tuberculosis medication is known to be helpful for making differentiation. We analyzed the colonoscopic findings before and after the tuberculosis treatment in patients with intestinal tuberculosis and atypical inflammatory bowel disease. Methods: From March 2002 to October 2004, We analyzed the colonoscopic findings before and after the tuberculosis treatment in 23 patients with intestinal tuberculosis and 25 patients with atypical inflammatory bowel disease. Mean duration for tuberculous medication is 107.3 days. Results: Ulcers are located at IC valve, AC and terminal ielum in both groups. There are no rectal and perianal lesion in both groups. Ulcers show geographic and irregular shape. Aphthous ulcers are common in IBD patients and transverse ulcers are common in intestinal tuberculosis patients (p < 0.05). After tuberculous medication, there are scarring and inflammatory polyps in patients with intestinal tuberculosis, but active ulcers are remained and sometimes aggravated in patients with inflammatory bowel disease (p < 0.05). On follow up, patients with inflammatory bowel disease were diagnosed as Crohn's disease in 13 patients, Bechet's enterocolitis in 8 patients and simple ulcers in 4 patients. Conclusions: In cases of atypical ulcers around IC valve, 3 months of anti-tuberculous treatment and colonoscopic follow up are valuable for making confirmative diagnosis and therapeutic plan.