Gastric Tuberculosis Research Articles

Gastric Tuberculosis

Gastric tuberculosis is a very rare disease posing a diagnostic challenge to physicians, pathologists and radiologists. It usually occurs in females aged 25 to 45 years. Symptoms include epigastric pain, vomiting, fever, weight loss, upper gastrointestinal (GI) bleed and gastric outlet obstruction. High index of suspicion and endoscopic or endoscopic ultrasound guided biopsies may help in making an early diagnosis, particularly in patients with non-healing gastric ulcers. We report a case of gastric tuberculosis in a 55-year male, who presented with persistent vomiting, epigastric pain and significant weight loss. His upper GI endoscopy finding with histopathology results favoured the diagnosis of gastric tuberculosis. He was successfully treated with antituberculous regimen.

Gastric Tuberculosis Simulating Gastric Malignancy: Case Report and Review of Literature

Gastric Tuberculosis Simulating Gastric Malignancy: Case Report and Review of Literature

Gastric lymphoma and gastric tuberculosis: A diagnostic dilemma

AbstractGastric outlet obstruction may be caused by a heterogeneous group of diseases that include both benign and malignant conditions. Primary gastric lymphoma (3%–5% of all gastrointestinal malignancies) and primary gastric tuberculosis (TB) (0.4%–2%) are very rare and resemble each other in clinical presentation with diagnostic dilemma between them. Do the two entities exist concomitantly or precede each other is still a topic of debate in the literature. Here, we present a case of primary gastric TB and gastric lymphoma in the same patient.

Gastric tuberculosis presenting as non healing ulcer: A case report

Tuberculosis is a major health problem in India. Gastrointestinal tuberculosis is the sixth most common causes of extrapulmonary tuberculosis and it mostly involves the ileocaecal region. Primary gastric tuberculosis in immunocompetent person is very rare. Stomach as its site is rare and is the sixth most common site of gastrointestinal tuberculosis. It mostly presents as a cases of non healing ulcer or gastric outlet obstruction. Yield of endoscopic biopsies for granuloma is low due to submucosal location of these lesions and mostly they are diagnosed after surgical intervention. We report a case of isolated gastric tuberculosis in a middle age immunocompetent female who present as a cases of non healing ulcer and responded well to standard antitubercular treatment. A high index of its suspicion should be kept in mind in any chronic infiltrative lesions of stomach like non healing ulcers and gastric outlet obstruction for its early diagnosis and treatment.

Granulomatous Gastritis: A Clinicopathologic Analysis of 39 Biopsy Cases

Introduction: Granulomas in gastric biopsy specimens are extremely rare. The final diagnosis of granulomatous gastritis is based on morphological findings, clinical and laboratory data. The aim of our study is to evaluate the clinical fields and to determine the etiology of gastric granulomatosis in our experience Patients and Methods: Thirty nine patients were reviewed retrospectively in the department of pathology of Habib Thameur between 2000 and 2018. Slides from all cases were stained by hematoxylin and eosin. The clinic-pathologic findings and the associated lesions were analyzed and the final etiology of the gastric granulomatosis was noted. Results: Biopsies from the 39 patients diagnosed as having granulomatous gastritis were reviewed. Mean age was 49 years (24 – 96) and sex ratio was 0,25 (M/F=8/31). Indication of endoscopy was gastric pain in 12 cases, chronic diarrhea in 6 cases, anemia in 2 cases, vomiting in 4 cases. Other symptoms were rare. Upper endoscopy was normal in 8 cases, showed antral gastropathy in 20 cases (erythematous in 6 cases, nodular in 8 cases and ulcerated in 6 cases). In four cases, fundic lesions were observed. Granuloma was unique in 14 cases and multiple in 25 cases. Localisation of granuloma was the antrum in 25 cases, the fundus in 7 cases, and both of them in 7 cases. An associated chronic gastritis was noted in 25 cases. Concerning the etiology, 10 of our patients had Crohn's disease while 6 of them had gastric tuberculosis. In five cases, H Pylori was the retained cause of gastric granulomatosis. In the other patients, the final diagnosis was sarcoidosis (n=3), foreign body reaction (n=1), yersiniosis (n=1). In our series, thirteen cases were unclassifiable. Conclusion: Although many cases remain unclassified, in most cases of granulomatous gastritis, a diagnosis of Crohn's disease or tuberculosis could be established. If this cases are excluded, an association between H. pylori and granulomatous gastritis cannot be ruled out. The others causes are extremely rare.

A rare case of primary gastric tuberculosis presenting as gastric outlet obstruction mimicking malignancy

<p>Gastric tuberculosis (TB), both primary and secondary is a rare condition. It is less common in immunocompetent individuals and in those without any antecedent pulmonary infection. The nonspecific complaints like epigastric pain, vomiting and weight loss may be confounding and lead to difficulty in diagnosis and differential diagnosis may include adenocarcinoma. We present a case of an immunocompetent male who presented with the above mentioned symptoms and on endoscopy showed an ulcerated region in the pyloric antrum with gastric outlet obstruction. A differential diagnosis of adenocarcinoma was suggested by the clinician. The endoscopic biopsy revealed granulomas and giant cells with no evidence of dysplasia. However, Ziehl-Neelson stain for acid fast bacilli was negative. The diagnosis of gastric tuberculosis was confirmed on Polymerase chain reaction (PCR) test for TB. A possibility of gastric tuberculosis should always be kept in mind in an endemic country like India with nonspecific abdominal complaints like epigastric pain, weight loss, vomiting etc. along with other differential diagnosis. A correct clinicopathological diagnosis would help in the appropriate treatment of the patient and would prevent unnecessary surgical excision.</p>

A case of postkidney transplant patient with gastric tuberculosis mimicking gastric malignancy

A 60-year-old male patient, who is a known case of end-stage kidney disease postliving donor renal transplantation on triple maintenance immunosuppression, presented with persistent dyspeptic symptoms 8 months posttransplant, not relieved with prolonged proton-pump inhibitor therapy. On endoscopy, found to have large ulcerated nodular lesion in the body of stomach suggestive of malignancy. On biopsy, it was diagnosed with primary gastric tuberculosis (TB). Complete clinical and endoscopic resolution was achieved following anti-TB treatment.

Gastric outlet obstruction: Report of an exceptional case

Although gastric outlet obstruction is a common condition, etiology could not be determined in a few cases by means of clinical features, radiological, and endoscopic examination, resulting in substantial diagnostic dilemma. A case is being described where a 30-year-old male presented with anorexia, dyspepsia, vomiting, low-grade fever, and weight loss for 2 months. Results of routine laboratory tests were within normal limit except elevated erythrocyte sedimentation rate. Abdominal computed tomography scan demonstrated a gastric outlet obstruction by an antral mass with mild enhancement of the area. Upper gastrointestinal endoscopy depicted an ulcerated and friable mass with an irregular shape and surface at pylorus resulting in pyloric obstruction. Endoscopic biopsy revealed only chronic gastritis with regenerative changes of epithelium. As the patient was not relieved of obstruction by conservative management, Billroth Type II gastrectomy was done. Histopathological examination of the resected specimen revealed caseating granulomas with acid-fast bacilli. Finally, the patient was diagnosed as primary gastric tuberculosis after exclusion affection of other organs and antituberculous medications was initiated. A good response to antitubercular treatment was noted after 5 months. Stomach being an uncommon site of tuberculosis and as it can occur in patients with no risk factors or characteristic symptoms, diagnosis of such rare condition remains a diagnostic enigma.

Tuberculous Gastric Abscess in a Patient with AIDS: A Rare Presentation

Tuberculosis is a healthcare concern that affects millions of individuals around the globe. Coinfection with HIV has changed both the clinical presentation and the outcome of the disease dramatically in the last few decades. Extrapulmonary tuberculosis is seen more frequently in the immunocompromised host. An unusual case of gastric tuberculosis in an AIDS patient is reported here. A 49-year-old female with AIDS was admitted for fever and epigastric pain. A gastric submucosal abscess was observed on imaging and confirmed by biopsy showing numerous neutrophils and acid-fast bacilli. Aspirate grew Mycobacterium tuberculosis. This report highlights a very unusual presentation of tuberculosis in an immunodeficient patient. High clinical suspicion for opportunistic infections in unusual locations should be maintained in these patients presenting with clinical syndromes that do not respond to standard treatments. New diagnostic modalities facilitate accurate identification of these infections.

Hematemesis: Unusual presentation of isolated gastric tuberculosis

A 25-year-old male presented with hematemesis, epigastric pain, and melena. He had dyspepsia with significant weight loss for 3 months period. On clinical examination, he was pale with no organomegaly or lymphadenopathy. The X-ray chest was normal, and ultrasound abdomen was normal. Upper GI endoscopy revealed nodularity and ulceration along proximal part of lesser curvature of the stomach. CT scan abdomen showed thickening of lesser curvature just below gastro-esophageal junction. The biopsies were negative for malignancy. Repeat upper GI endoscopy showed a nonhealing ulcer, on repeat well biopsies taken from the base of ulcer primary gastric tuberculosis was diagnosed. It showed many epithelioid cell granulomas and multinucleated giant cells with caseous necrosis on histology. Acid-fast bacilli on Zeil Neelsen staining and TB PCR were positive for Mycobacterium tuberculosis. He was put on four-drug anti-tuberculous treatment. On follow-up, the patient gradually improved and regained weight. Repeat upper GI endoscopy done after 8 weeks showed healing of the ulcer with decrease in nodularity.

Primary gastric tuberculosis mimicking a submucosal tumor

AbstractGastric tuberculosis is very rare and is usually associated with pulmonary tuberculosis. Endoscopically, it usually resembles peptic ulcer disease or malignancy. We present a 28-year-old female who had a submucosal lesion in the body of the stomach that mimicked a submucosal tumor. Endoscopic ultrasound guided fine needle aspiration yielded caseous material, and the cytological examination confirmed the diagnosis of tuberculosis.

Isolated gastric tuberculosis masquerading as chronic peptic Ulcer: A case report

Abdominal Tuberculosis (TB) most commonly affects ileo-caecal region. Isolated stomach involvement by TB, without pulmonary infection is rare. Clinical presentation of Stomach TB may be non-specific, radiological findings non-contributory and superficial endoscopic biopsies may not be able to settle the diagnosis. Many cases are diagnosed only after histopathological examination of surgical specimens. High degree of suspicion is needed for early diagnosis of gastric tuberculosis, if unnecessary surgical interventions are to be avoided. A young patient who was being treated as a case of chronic peptic ulcer for one year was referred for treatment of gastric outlet obstruction. Histopathological examination of gastrectomy specimen of the patient showed multiple caseating granulomas characteristic of tuberculosis and presence of acid-fast bacilli on Fite-Faraco staining, with no evidence of tuberculosis at pulmonary or other body sites. This case of isolated gastric TB is reported for its rarity.

Tuberculosis gástrica que simula otra patología: caso clínico

Gastrointestinal tuberculosis is a rare entity that mimics other pathologies. It is commonly associated with late diagnosis due to its clinical characteristics and atypical presentation in these types of organs. Data were taken from the medical record of a patient following informed consent. Clinical characteristics, initial focus, endoscopic findings, and similarities with other pathologies are described, and a topic review was done. Initially, gastric tuberculosis mimicked other pathologies causing a delay and difficulty to issue correct diagnosis and treatment. This entity has variable and nonspecific clinical manifestations which can be confused with other entities due to clinical similarities and infrequent presentation. There is scarce literature and most is limited to isolated case reports with benign behavior and adequate response to TB treatment.

Gastric tuberculosis misdiagnosed as a submucosal tumor: A case report

Gastric tuberculosis misdiagnosed as a submucosal tumor: A case report

Insights from paleomicrobiology into the indigenous peoples of pre-colonial America - A Review

This review investigates ancient infectious diseases in the Americas dated to the pre-colonial period and considers what these findings can tell us about the history of the indigenous peoples of the Americas. It gives an overview, but focuses on four microbial pathogens from this period: Helicobacter pylori, Mycobacterium tuberculosis, Trypanosoma cruzi and Coccidioides immitis, which cause stomach ulceration and gastric cancer, tuberculosis, Chagas disease and valley fever, respectively. These pathogens were selected as H. pylori can give insight into ancient human migrations into the Americas, M. tuberculosis is associated with population density and urban development, T. cruzi can elucidate human living conditions and C. immitis can indicate agricultural development. A range of methods are used to diagnose infectious disease in ancient human remains, with DNA analysis by polymerase chain reaction one of the most reliable, provided strict precautions are taken against cross contamination. The review concludes with a brief summary of the changes that took place after European exploration and colonisation.

Gastric tuberculosis presenting with a huge abdominal mass

Tuberculosis of the stomach is extremely rare. We report the case of a 38-year-old woman who presented with epigastric discomfort and a palpable mass that persisted for a period of one month. We also report our findings from the abdominal computed tomographic, upper endoscopic and endoscopic ultrasonographic examinations of the patient. Abdominal computed tomography (CT) showed the presence of a large mass with an irregularly contoured low attenuation lesion. Upper endoscopy and endoscopic ultrasonography revealed a protruding ulcerative mass with an ill-defined heteroechoic subepithelial lesion originating from the gastric submucosal layer. This was previously misdiagnosed as a gastrointestinal stromal tumour. Endoscopic biopsy specimen was positive on acid-fast bacillus staining, and polymerase chain reaction for Mycobacterium tuberculosis was also positive. Abdominal CT and endoscopy at the patient's three-month follow-up showed near complete resolution of the lesion.

HIV Infection in Gastric Epithelial Cells

Many chronic human immunodeficiency virus (HIV) patients suffer from gastric complaints, including gastric tuberculosis and coinfection of other pathogens. Recent work has demonstrated that a variety of nonimmune cells can act as viral reservoirs, even at the early stage of HIV infection. In this study, we detect HIV viral particles, proteins, and nucleic acids in gastric epithelial cells using clinical samples. These observations are further supported by a simian immunodeficiency virus-infected macaque model. Further, the number of HIV-infected gastric epithelial cells is positively associated with blood viral load, and is negatively correlated with CD4 lymphocyte cell counts. We also demonstrate that HIV infection is accompanied by severe inflammatory response in gastric mucosa. Additionally, HIV infection activates signal transducer and activator of transcription 3 and RelA, and enhances the production of interleukin 6 and tumor necrosis factor α in gastric epithelial cells. The present data suggest that the gastric epithelial cells are natural targets of HIV infection, and HIV infection in epithelial cells contributes to HIV-induced gastric mucosal inflammation.

Primary gastric tuberculosis mimicking gastric cancer: a case report

Gastric tuberculosis is an uncommon manifestation of extra-pulmonary tuberculosis infection. The clinical signs of this type of infection are nonspecific and misleading. Clinically gastric tuberculosis resembles peptic ulcer disease or malignancy. We report a case of gastric tuberculosis, which was treated as acid peptic disease, in an Iranian immunocompetent adult with no pulmonary tuberculosis, who received surgery for gastric cancer. Diagnosis was based on PCR despite the detection of negative acid-fast bacilli in the histopathologic specimen. We recommend PCR for Mycobacterium tuberculosis to be done when granuloma or caseation is detected on biopsy in patients who are suspected of having gastric malignancy or acid peptic diseases.

Gastric Tuberculosis with Outlet Obstruction: A Case Report Presenting with a Mass Lesion

Tuberculosis is a major health problem worldwide. In India, it is highly endemic. The most common manifestation is a pulmonary disease, but involvement of the gastrointestinal tract is not uncommon with the ileocecal region being the commonest site. Gastric tuberculosis is rare and usually associated with pulmonary tuberculosis or an immunodeficient state. Here, we report a case of gastric tuberculosis presenting as gastric outlet obstruction in an immunocompetent patient without evidence of pulmonary tuberculosis. Biopsy and PCR confirmed the diagnosis, and the patient responded well to standard antitubercular treatment. Though, gastric tuberculosis is rare, it should be considered as a possibility when patients present with gastric outlet obstruction, particularly in endemic areas with tuberculosis.

Primary duodenal tuberculosis presenting as gastric-outlet obstruction: Its diagnosis

Gastrointestinal tuberculosis often involves the ileocecal region. Duodenal and gastric tuberculosis found in only 1% of patients suffering from pulmonary tuberculosis with associated HIV infection in non-endemic areas. Duodenal obstruction due to tuberculosis is very rare and needs high index of suspicions for diagnosis. Mostly this entity is suspected on intraoperative findings. In this manuscript we emphasized on ways and means for establishing histopathological diagnosis before starting anti-tubercular treatment in such cases. All patients of suspected gastroduodenal tuberculosis presented with feature of gastric-outlet obstruction managed during Jan 2009 to June 2011 were included in the study. After proper evaluation (routine hematological and biochemical examination, microbiological examination, serological and endoscopic evaluation) exploratory laparotomy was done and if there is no mesenteric lymphadenopathy or it is not safe to take biopsy form the diseased duodenum, multiple FNAC were taken from the diseased portion for histopathological and microbiological diagnosis. A total of five patients were treated during this period. The most common presentation was vomiting followed by failure to thrive and weight loss; two patients had abdominal pain. Biopsy of mesenteric lymph node was possible in two cases. FNAC from diseases portion was taken in all cases. FNAC showed granulomas in four cases. Cases where even FNAC finding was non-conclusive on HPE/Microbiology was not subjected to antitubercular drug. Multiple intra-operative FNAC may be taken from the diseased portion of the duodenum to establish the histopathological diagnosis if diagnosis is not established by any other mean.