Intestinal TB Research Articles

A rare case of intestinal obstruction due to tuberculosis.

A 19-year-old previously healthy patient presented with severe abdominal pain. A contrast-enhanced CT scan identified ileal obstruction and lower left lung lobe changes suggestive of an inflammatory process. Diagnostic laparoscopy revealed ileal distension, hyperemia, and whitish nodules on the serosa. Acid-fast bacilli staining was positive, confirming Mycobacterium tuberculosis infection. The patient improved with a tuberculosis regimen. Intestinal TB often affects the ileocecal area and presents with symptoms like abdominal pain and obstruction. Diagnosis is confirmed by AFB staining, and treatment mirrors pulmonary TB, though surgery may be needed for complications.

New diagnostic strategies to distinguish Crohn's disease and gastrointestinal tuberculosis.

Despite advances in our radiological, histological and microbiological armamentarium, distinguishing between Crohn's disease (CD) and intestinal tuberculosis (ITB), especially in a TB endemic country, continues to be a challenging exercise in a significant number of patients. This review aims to summarize current available evidence on novel diagnostic techniques which have a potential to fill the gap in our knowledge of differentiating between ITB and CD. Both ITB and CD are associated with altered host immune responses, and detection of these altered innate and adaptive immune cells has potential to distinguish ITB from CD. ITB and CD have different epigenetic, proteomic and metabolomic signatures, and recent research has focused on detecting these differences. In addition, the gut microbiome, which is involved in mucosal immunity and inflammatory responses, is considerably altered in both ITB and CD, and is another potential frontier, which can be tapped to discriminate between the two diseases. With technological advancements, we have newer radiological modalities including perfusion CT and dual-layer spectral detector CT enterography and evidence is emerging of their role in differentiating ITB from CD. Finally, time will tell whether the advent of artificial intelligence, with rapidly accumulating data in this field, will be the gamechanger in solving this puzzle of diagnostic dilemma between ITB and Crohn's disease. Recent advances need to be clinically validated before they can be used as novel diagnostic measures to differentiate Intestinal TB from CD.

Latent tuberculosis infection in myasthenia gravis patients on immunosuppressive therapy: high incidence yet moderate reactivation rate

Background Immunosuppressive therapies (ISTs) are mainstays for management of myasthenia gravis (MG). Meanwhile, latent tuberculosis infection (LTBI) is common in the setting of high-burden countries. However, the prevalence of LTBI among MG patients and whether receiving ISTs for MG would aggravate LTBI reactivation remain unknown. Methods We retrospectively analyzed the frequency of LTBI via interferon-gamma release assay (IGRA) positivity among hospitalized MG patients from both rural and urban areas in a tertiary hospital, and those receiving ISTs were followed up to investigate the reactivation risk of LTBI. Results A total of 300 MG patients with determinate IGRA results were enrolled, where the frequency of LTBI was 35.0%. Male (OR = 1.910, 95% CI: 1.181–3.089, p = .008) and elderly (OR = 1.044, 95% CI: 1.027–1.061, p < .001) patients were prone to LTBI. Of those with LTBI, 78 individuals on ISTs were successfully followed up for a median duration of 18.3 (8.5–24.0) months, of which 25 (32.1%) received anti-tuberculosis (TB) treatments. The rate of various degrees of adverse events was 82.1% over the course of the follow-up, but was not different between individuals with and without therapies against TB (χ 2 < 0.001, p > .999). Only 1 patient eventually reported lymph node and intestinal TB, with the incidence rate of LTBI reactivation preliminarily estimated to be 0.81 per 100 person years. Conclusion The frequency of LTBI is high in our MG cohort, especially among those with advanced age and males. However, receiving immunosuppressives seems not to increase the risk of LTBI reactivation. LTBI screening is strongly recommended for all MG patients ready to receive ISTs, while preventive anti-TB chemotherapy should be prescribed after weighing potential benefits against the risk of side effects in those with LTBI. In-depth investigation is still entailed to further verify these findings due to the limitation of the retrospective single-center design of our study.

Intestinal helminth co-infection and associated factors among pulmonary tuberculosis patients in Africa and Asia: a systematic review and meta-analysis

IntroductionTuberculosis (TB) and intestinal helminths have huge public health importance, and they are geographically overlapped. Data about the burden of intestinal helminth and TB co-infection in these areas are fragmented. In this systematic review and meta-analysis we compile the current literatures and generate pooled prevalence. We also identity factors associated with intestinal helminth co-infection among TB patients.MethodsOriginal articles published in English language up to March 23, 2022 were systematically searched from electronic database (PubMed/Medline, Scopus, Science Direct, Google Scholars and HINARI). The search was done using medical subject heading terms and keywords. Identified articles were exported into the EndNote library. The identified articles were screened using PRISMA flow diagram. Then the methodological quality of included articles was evaluated and rated using the modified version of Newcastle–Ottawa Scale. Data were extracted using Microsoft Excel. Sensitivity analysis and Egger regression test were used for the assessment of heterogeneity and publication bias. Finally the results are presented with a meta-analysis of pooled estimates, forest plots, and tables. The quantitative data were analyzed using Stata version 14.ResultsFrom a total of 5457 searched articles, 22 eligible articles were included in the review. The pooled prevalence of helminth co-infection among TB cases was 29.69% (95%CI: 21.10, 38.29). TB patients were found to more frequently harbor one or more intestinal helminths than TB negative individuals (OR = 1.72 (95%CI: 1.20, 2.48)). Among the reported helminths, Schistosoma mansoni and Strongyloides stercoralis had the highest pooled prevalence among TB cases. However, unlike other individual helminths, only Strongyloides stercoralis (OR = 2.67 (95% CI, 1.20–6.76)) had significant association with TB cases compared to TB negatives. BMI was significantly associated with intestinal helminth co-infection among TB patients (OR = 2.75 (95%CI: 1.19, 6.38)).ConclusionsPatients with TB have been shown to harbor co-infection with one or more intestinal helminths with considerable proportions when compared with TB-negative individuals. The higher prevalence of helminth infection in TB cases might indicate that co-infection promotes active TB disease. Thus, routine intestinal helminth screening and assessment of their nutritional status is suggested for TB patients.

A meta-analysis of the accuracy of Xpert MTB/RIF in diagnosing intestinal tuberculosis.

A detection method with high efficiency and accuracy is urgently needed in clinical work. The purpose of our study was to determine the diagnostic accuracy of the Xpert MTB/RIF assay for intestinal tuberculosis (ITB). We searched PubMed and 4 other databases from their establishment to July 19, 2022, for published essays of diagnostic performance in which Xpert MTB/RIF was used to test patients with clinically suspected ITB. An assessment of the quality of the selected literature was conducted using QUADAS-2. We built forest plots by MetaDiSc software. The pooled Xpert MTB/RIF sensitivity was 48%, and the specificity was 99%. Moreover, the positive likelihood ratio for ITB diagnosis was 21.61. The negative likelihood ratio was 0.54. There were substantial variations between the study estimates of sensitivity (I2 = 87.6%) and specificity (I2 = 82.4%). Intestinal TB is detected with limited diagnostic sensitivity by Xpert MTB/RIF but with high specificity. An Xpert-positive result may facilitate the rapid identification of ITB cases. Nevertheless, a negative result has less certainty in excluding the disease.

Colonoscopic Evaluation of Patients Treated Conservatively for Intestinal Obstruction: An Observational Study

Background: Acute intestinal obstruction occurs when there is an interruption in the forward flow of intestinal contents. This interruption can occur at any point along the length of the gastrointestinal tract, and clinical symptoms often vary based on the level of obstruction. Objectives: To evaluate the causes of obstruction of patients who were treated conservatively for acute intestinal obstruction. Materials &amp; Method: A cross-sectional observational study. The study was carried out in the Surgery In-patient Department of Comilla Medical College Hospital, Comilla, from 01.07.2013 to 31.12.2013. A total of 246 patients got admitted to the surgery in-patient department and diagnosed as a case of intestinal obstruction. 101 patients of both sex, aged 23-79 responded to initial conservative treatment and were recruited for the study. The remaining 145 patients underwent emergency surgery for intestinal obstruction and were excluded from the study. All data gathered from the data collection sheet was compiled manually. After compilation, these data were shifted to statistical analysis software for further analysis. Results: Out of 246 intestinal obstruction patients, we recorded 101 patients who responded to conservative management. 59 (58.4%) patients were male, and the remaining were female. Peak Incidence (45.5%) was in 51-66 years age group. 54(53.4%) patients presented with large bowel obstruction, the remaining with small bowel obstruction. Most of the patients 68 (67.3%), presented with sub-acute obstruction, followed by acute 28 (27.7%) and chronic 5 (4.9%) obstruction, respectively. 12(11.8%) patients were diagnosed with colorectal carcinoma, 5(4.9%) patients with intestinal TB, and 1(0.9%) patient with diverticulosis. 10(83.3%) of the patients with Colorectal carcinoma were in the elderly age group (&gt;50 years) whereas two patients were below 80 years of age. The cause of obstruction could not be detected in 83 (82.2%) patients by colonoscopy. ..............

Tuberculosis Presenting as Intestinal Granulomas in a Patient from West Virginia

uberculosis (TB) is relatively uncommon in West Virginia compared to surrounding Appalachia and the rest of the country. Despite the low prevalence, it is essential to diagnose promptly given the high potential for significant disease burden. Miliary TB is a form of disseminated Mycobacterium tuberculosis infection resulting from hematogenous spread of the organism. Known risk factors for developing disseminated TB include immunosup-pressant medications, human immunodeficiency virus infection, and extremes of age. We present a case in which a patient without identifiable risk factors for TB developed intestinal TB that had been misdiagnosed as Crohn's disease. Shortly after being started on immunosuppressant therapy for the presumed inflammatory bowel disease, the patient developed significant miliary TB

Expression of vascular endothelial growth factor (VEGF) and platelet endothelial cell adhesion molecule (PECAM-1/CD31) in intestinal tuberculosis

• Epithelioid cell granulomas have hypoxic microenvironment acting as a stimulus for angiogenesis . • The significantly increased number of vessels were seen in the granulomatous areas compared to non-granulomatous areas indicating the role of neo-angiogenesis in disease pathogenesis. • VEGF expression was markedly reduced in the mucosal epithelium of granulomatous area suggesting defective VEGF production by the intestinal epithelium making it prone to injury. • Altered vasculature of the granuloma associated vessels might be a potential therapeutic target for intestinal TB in future, in conjunction with anti-tubercular treatment.

Surgical Presentation of Abdominal Tuberculosis at a University Hospital

Aim: To determine various surgical presentation of abdominal tuberculosis Study design: cross sectional study Place and duration: This study was conducted at Peoples University of Medical &amp; Health Sciences for Women (PUMHS-W) Nawabshah Pakistan from October 2017 to march 2020. Methodology: The data in this study were from cases of abdominal TB that were admitted as an acute or subacute abdominal emergency. The data of the patients were analyzed using SPSS version 22. Descriptive analysis was used to examine the data. The data was presented using numbers and percentages. Results: Females made up 62.66 % of the 150 cases. A total of 55.33 % of the cases were between the ages of 30 and 50 years. No history of TB was shown in 60.66% of the cases and a history of pulmonary TB was found in 26.66 % of the cases. In 96.66% of patients, abdominal pain was present, followed by vomiting in 52 % and fever in 22 %. 60.66 percent of the cases were classified as having subacute intestinal obstruction, whereas 39.33 % had acute abdominal symptoms. The most common symptom was abdominal pain, and the most common clinical presentation was subacute intestinal obstruction. Early identification is crucial for avoiding intestinal TB's systemic and local effects. Conclusion: Intestinal obstruction was the most common clinical presentation of abdominal tuberculosis followed by intestinal obstruction. Acute abdominal TB is one of the most common causes of acute abdomen in endemic areas, as intestinal TB is a common extrapulmonary manifestation of TB. The key to avoiding systemic and local consequences of intestinal TB is early detection. Keywords: Abdominal, Clinical presentation, Intestinal, Symptoms, Tuberculosis

P242 Latent Tuberculosis: frequency of occurrence and effect on clinical, laboratory, endoscopic and morphological activity of the course Inflammatory Bowel Diseases

Abstract Background Early diagnosis of tuberculosis remains challenging due to the nonspecific clinical manifestations that can mimic other gastrointestinal diseases and range from acute to chronic abdominal disease. In recent decades, latent tuberculosis (LTI) has been of particular interest. Patients with inflammatory bowel disease (IBD) are at risk of contracting tuberculosis. Aim to identify the incidence of LTI in patients with IBD and its effect on the clinical, laboratory, endoscopic and morphological activity of IBD. Methods The study included 350 patients with IBD, who were monitored and a group of patients (188 people (UC = 80, CD = 101, MC = 7) who did not respond / or poorly respond to basic IBD therapy were identified. In this group, the determination of the quantiferon test was carried out. To achieve this goal, two main hypotheses were considered: assessment of IBD-associated and systemic vascular lesions (h/s CRP, platelet count, homocysteine, vit D, urine albumin, fecal calprotectin and lactoferrin; α-TNF, IL-1,IL-2,IL-4,IL-6,IL-8,IL-10,IL-18; endoscopic examination with pathomorphological assessment), assessment of changes in the thickness of the vascular intima and blood flow velocity (based on the doppler determination of the pulse wave velocity (PWV) and the thickness of the intima media (CIMT) on the common carotid, vertebral and subclavian arteries). Results The number of positive responses to the quantiferon test was found in 37 patients (19.7%) / 10.6%) out of 188 patients (53.7%); positive skin tests (Mantoux reaction) ≥5 mm in 78 (22.3%) patients; altered peritoneal lymph nodes in 28 (8%), pulmonary and pleural TB in 9 (2.57%) patients. There were no patients with intestinal TB / “+” TB PCR in the gastrointestinal tract tissue. The prevalence of positive cases according to the quantiferon test was: in the general group of patients - 10.6%. Laboratory indicators for both IBD and systemic vascular lesions were higher in the group of patients with latent tuberculosis (Table 1, Table 2). Damage to the vascular bed (based on doppler determination of pulse wave velocity (PWV) and intimal thickness (CIMT) on the common carotid, vertebral and subclavian arteries) was more pronounced in the group of patients with latent tuberculosis (CIMT (mm) 0.68 ± 0, 1 / 0.67 ± 0.2; PWV (sm / s) 93.3 ± 2.2 / 97.2 ± 1.4). Conclusion Conclusion. Comparing the results of the data before and after the treatment of latent TB in patients with IBD, certain dependences of the influence of infection on the course of IBD (h/s CRP, platelet levels, homocysteine, fecal calprotetin and lactoferrin, IL-8 and a decreased vit. D; changes, associated with damage to the vascular bed), endoscopic and morphological activity.

An outcome-based composite approach for the diagnosis of intestinal tuberculosis: a pilot study from a tertiary care centre in South India.

The diagnosis of intestinal TB (ITB) is challenging because of its overlapping features with Crohn's disease. This outcome-based study evaluated the combination of colonoscopy, histopathology, Xpert MTB/RIF and TB culture for best sensitivity and specificity. This was a four-year retrospective, observational study of 426 clinically suspected patients who underwent colonoscopy with biopsies for histopathology, Xpert MTB/RIF and TB culture. ITB was diagnosed using the composite reference standard (CRS), which comprised either histological features or culture or Xpert MTB/RIF positivity, and positive response to anti-tuberculous treatment on follow up. 35 (8.2%) patients were diagnosed with ITB. Histopathology had the highest sensitivity (91.4%) and negative predictive value (99.2%), MTB/RIF had the highest specificity (100%) and positive predictive value (100%). A combinatorial approach with Xpert MTB/RIF and histopathology had optimal diagnostic value (97%), approaching 100% sensitivity with culture. 40% of cases were diagnosed within 12 hours with Xpert MTB/RIF and 97% cases within three days. This combinatorial diagnostic model provides rapid and reliable diagnosis of ITB which may be useful in endemic areas.

Prevalence of intestinal parasites and its association factors, knowledge, attitude and practice about intestinal parasite Saint Peter TB specialized hospital Addis Ababa, Ethiopia

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Intestinal parasitic infections and HIV/AIDS have been the leading and persisting public health problems in the world. There vital causes of morbidity and mortality are remarkably high in Sub-Saharan Africa.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A cross-sectional study was conducted among patients attending Saint Peter hospital from December 2019 to May 2020. A total of 328 participants were select by using convenient sampling method. Socio-demographic data and knowledge, attitude and practice were collected using a structured questioner. Stool specimen was collected using clean container and processed and analyzed for parasitological examination using direct wet mount, formal-ether sedimentation and modified Ziehl-Neelsen (ZN) staining techniques. Venous blood was collected and the CD4+ T-lymphocyte and hemoglobin analyzed by Presto instrument. The data were analyzed by using SPSS version 23 and p values less than 0.05 were considered statistically significant.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 328 HIV-positive individuals (59.8% female) of age ranging from 13-72 years (mean=41.8, SD=10.8) participated in this study. The overall prevalence of intestinal parasites among the study participants was 26.2% (86/328), from this 88.4% (76/86) was infected by single parasite. IP was significantly associated with CD4 count &amp;lt;200 AOR (4.736 CI: 2.338-9.594; p&amp;lt;0.001) and also anemia AOR (3.271 CI: 1.069-10.010).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Intestinal parasitic infections are still common health problems among HIV/ADIS patients in the study area, so the health professionals need to give attention to parasitological examinations in the routine treatment of HIV/AIDS patients and also give education on these three parts knowledge, attitude and practice, but more focus and follow up on the practice of HIV/AIDS patients on transmission, prevention and control mechanisms of intestinal parasitosis.&lt;/p&gt;

Chronic Diarrhea in Children: Experience at A Tertiary Hospital of Bangladesh

Background: Chronic diarrhea is insidious onset that persists for 14 days and more, usually of noninfectious origin. Chronic diarrhea in children is not an uncommon problem in our country.&#x0D; Objectives: Objective of this study was to evaluate children with chronic diarrhea by clinical-biochemical profile and outcome.&#x0D; Methods: It was a retrospective observational study done in the department of paediatric gastroenterology and nutrition, BSMMU. The study was done during January 2017 through December 2018. Forty-five patients diagnosed as chronic diarrhea between the ages of 6 months to 18 years were included in this study. We Clinical, laboratory data and outcome of patients were analyzed.&#x0D; Results: Mean age of children was 5.96±2.3 year, 60%(27) were male and 40% (18) were female. Among them under 5 years were 55%(25). All children presented with diarrhea (100%) along with fever (24%), FTT (22%), abdominal pain (20%) and weight loss (20%). About 58% of children had anemia and 14% had hepatomegaly and/or splenomegaly. Raised ESR (40%), leukocytosis (20%), thrombocytosis (16%), raised CRP (13%) and electrolyte imbalance (16%) were observed. Intestinal TB (18%) was the most common etiology of chronic diarrhea. Moreover, chronic constipation with fecal incontinence mimicking diarrhea (11%), IBD (9%), coeliac disease (8%), IBS (7%), HIV enteropathy (4%), primary immunodeficiency disorder (4%) were also found. Improvement of diarrhea was observed in 96% children, 4% patient died due to diarrhea-related complications.&#x0D; Conclusion: Chronic diarrhea in children is not uncommon in Bangladesh and diagnosis of etiologies are challenging. Intestinal tuberculosis found to be an important cause of chronic diarrhea in this study. Although in the majority of the cases, etiology could not be identified, some remote etiologies were found on this study, like chronic constipation with fecal incontinence mimicking diarrhea, IBD, HIV enteropathy, primary immunodeficiency.&#x0D; DS (Child) H J 2020; 36(1) : 46-51

Intestinal TB v/s Crohn’s disease –Mystery solved?

In countries like India where TB is endemic, it is extremely difficult to differentiate between Intestinal-TB and Crohn’s-disease as both have overlapping clinical, radiological, endoscopic and histological features [1-4]. Incorrect diagnosis causes increased morbidity and mortality. Hence, there is a need for an imaging test that can accurately diagnose both and can be easily integrated into existing clinical practice. We describe a new technique of CT perfusion for differentiation between the two diseases. We present 2 cases (biopsy proven) of intestinal-TB and Crohn’s-disease. The clinical, laboratory investigations, imaging and endoscopic findings will be discussed along with analysis of the perfusion parameters. The final diagnosis will be considered according to the biopsy findings. We conclude that CT perfusion is a highly sensitive and specific non invasive imaging modality for differentiation between intestinal-TB and crohn’s-disease.

S0835 Crohn’s Disease Among the Poorest Billion: Survey Data From Low and Lower Middle-Income Countries

INTRODUCTION: While Crohn’s Disease has been studied extensively in high-income countries, its epidemiology and care in low and lower-middle income countries (LLMICs) is not well established due to a lack of disease registries and diagnostic capacity. This study aims to understand how IBD and Crohn’s impacts the world’s poorest. METHODS: We conducted a cross-sectional survey of gastroenterology providers in countries where the poorest billion live to determine the state of diagnostic and treatment capacity for Crohn’s in LLMICs. Quantitative data was analyzed in R and Excel. RESULTS: Of the 84 providers who expressed interest and were sent the survey link, a total of 46 survey responses from 15 countries were included, giving a response rate of 54.8% (Figure 1). The mean number of patients diagnosed with Crohn’s cared for in the last year was 89.5 overall and varied widely from 0 reported at one facility in Rwanda, to 1,000 reported at two different facilities in India (Table 1). Overall, Crohn’s disease made up 20.6% of the IBD diagnoses reported by survey respondents, with Africa having a larger proportion of Crohn’s compared to ulcerative colitis (UC) than Asia. Most of the providers reported that patients with Crohn’s typically have symptoms for between 6 and 24 months prior to diagnosis and that 26–50% of their patients live in rural areas. The most commonly reported diagnostic challenge is differentiating between Crohn’s and intestinal tuberculosis where it was reported by 70.5% of providers (Figure 2A). Gastroenterologists in Africa struggle with poor Crohn’s disease awareness among providers (47.7%) and lack of trained pathologists (36.4%). First- line Crohn’s medications and IBD surgeries like colectomy and small bowel resection are widely available while the availability of more advanced surgeries and medications is much more variable. The most widely reported challenge in managing Crohn’s disease is patients’ inability to afford biologics, reported by 65% of providers (Figure 2B). CONCLUSION: There appears to be a greater burden of Crohn’s disease in LLMICs than is indicated in the literature. While it appears that most Crohn’s patients are from urban areas as is described in the literature, there does appear to be a signal of Crohn’s in rural areas. Respondents reported many challenges in diagnosing and treating Crohn’s disease, including differentiating it from intestinal TB, poor awareness among providers, and patients’ inability to afford diagnostic testing and treatments like biologics.Figure 1.: Number of survey responses from each LLMIC included in the analysis (A); Number of gastroenterologists and endoscopy centers in each country as reported by survey respondents (B).Table 1.: Mean and range number of patients diagnosed with IBD and Crohn’s cared for in the last year, and percentage of IBD that is diagnosed as Crohn’s, reported overall, by region, and by countryFigure 2.: Challenges faced by providers in diagnosing Crohn’s disease, across all LLMICs (A); Challenges faced by providers in managing Crohn’s disease, across all LLMICs (B).

PREVALENCE, DISTRIBUTION AND DETERMINANTS OF INTESTINAL TUBERCULOSIS IN ADULT INDOOR PATIENTS WITH ACUTE SMALL INTESTINAL OBSTRUCTION IN POPULATION OF PESHAWAR DIVISION, PAKISTAN

Background: Acute small intestinal obstruction (ASIO) is one of the commonest causes of emergency hospital admissions, morbidity and mortality. Intestinal tuberculosis (ITB) is common cause of ASIO in developing countries leading to significant morbidity and mortality. Our objectives were to determine prevalence, distribution and determinants of ITB in adult indoor patients with ASIO in population of Peshawar Division, Pakistan.Materials Methods: This cross-sectional study was conducted at Department of Surgery Peshawar Medical College, Peshawar, Pakistan from January 2019 to June 2020. The data was collected from its three affiliated hospitals; Mercy Teaching Hospital, Kuwait Teaching Hospital Prime Teaching Hospital, Peshawar. 207 ASIO subjects were selected from population at risk consecutively. Sex, age groups and presence of ITB were variables. Prevalence and distribution were described by count, percentage and confidence intervals for proportion for population. Hypotheses for distribution were tested by chi-square goodness of fit and of association by chi-square test of association.Results: Out of 207 patients with ASIO, 128 (61.84%) were men and 79 (38.16%) women, 87 (42.03%) were in age group 18-40 and 120 (57.97%) in 41-60 years. Out of 207 patients with ASIO, 41 (19.81%) had ITB, while 166 (80.19%) had no ITB. Out of 41 ITB patients, 25 (12.08%) were men and 16 (7.73%) women, 17 (8.21%) in age group 18-40 and 24 (11.60%) in 41-60 years. The prevalence of ITB was similar to expected (p=.5695). The distribution across sex (p=.00001) was different and across age groups (p=.12501) was similar to expected. Presence of ITB was not associated to sex (p=.8992) and age groups (p=.9347).Conclusion: Prevalence of intestinal TB in adult indoor acute small intestinal obstruction (ASIO) population of Peshawar Division, Pakistan was 19.81%. Prevalence was higher in men than women and higher in 41-60 years than 18-40 years age group population. Overall prevalence of intestinal TB was similar to expected. Observed distribution across sex was different and across age groups was similar to expected. Presence of intestinal TB was not associated to sex and age groups respectively.

GIST as a Lead Point in Adult Intussusception: Study in a Tertiary Hospital

Introduction: Intussusception is very common in childhood between the ages of 5 months to 1 year. In adults it is a rarity, in whom it commonly presents with a nonspecific, repeated, chronic or subacute intestinal obstruction. Ninety percent of them have a variable number of secondary pathological ‘lead point’- from benign lesion to malignant.5&#x0D; Objective: This study aims to find out the variations &amp; the commonest ‘Lead points’ in rare adult intussusceptions.&#x0D; Methodology: Study period was from January 2015 to June 2019. All patients of adult intussusceptions, admitted in Shaheed Suhrawardy Medical college Hospital, were examined, investigated, &amp; analysed peri-operative findings with post-operative histopathological results, in this prospective observational study.&#x0D; Result: In this study, among 15 patients, GIST found to be the commonest (46%) Lead point in adult intussusceptions. Others include Adenocarcinoma, Leiomyomatous polyp, Meckel’s Diverticulum, intestinal TB, etc. Male was mostly sufferer (67%). Ileoileal (II) variety was found more in male &amp; Ileocecal (IC) variety in female.&#x0D; J Shaheed Suhrawardy Med Coll, December 2019, Vol.11(2); 138-141

A Ten-Year Retrospective Study on the Clinical Features and Outcomes of Pediatric Intestinal Tuberculosis Admitted in UP-Philippine General Hospital

Objective. To describe the clinical, biochemical, microbiologic, radiologic and histological features and outcome of intestinal TB.Methods. Medical records of patients diagnosed with intestinal TB were reviewed. Cases were considered bacteriologically-confirmed if intestinal tissue was positive on smear culture or polymerase chain reaction (PCR); and clinically-diagnosed if with clinical, histologic, and radiologic evidence of extra-pulmonary TB. Results. Fifteen patients [Mean (SD) age: 13 (4) years; 53% females] were included. One was bacteriologicallyconfirmed; and fourteen were clinically-diagnosed. Fever (87%) and abdominal pain (73%) were commonly seen. Seven (47%) had anemia, 5 (33%) leukocytosis and 10 (71%) hypoalbuminemia. Eleven (73%) were positive on smear or TB PCR of various specimens. Nine of 10 (90%) patients with an abdominal CT scan had thickening of bowel loops. Three with intestinal biopsy demonstrated caseation granuloma. Fourteen patients were given quadruple anti-TB medications. Six had surgery, 8 had no disease-related complications, 4 died of sepsis and 3 were lost to follow up.Conclusion. Intestinal TB presents with non-specific clinical and laboratory features. Radiologic findings may provide a clue to the diagnosis. Histologic confirmation in intestinal tissue was only seen in a few cases. The prognosis was favorable for patients who completed the anti-TB treatment.

Inflammatory bowel disease in Africa: what is the current state of knowledge?

Inflammatory bowel disease (IBD) is increasingly recognized as a global disease in the twenty-first century; however, little is known about its epidemiology in Africa. We conducted a literature review in order to assess what is currently known on this subject, the results of which are reported here. Based on available observational studies, it appears that the incidence of IBD in Africa is rising, although comprehensive epidemiological data are lacking. This is likely due to multiple factors, including shifting trends in diet and exposure to environmental pathogens. Many challenges relating to IBD exist for healthcare systems in Africa, including the need for improved access to diagnostic facilities such as endoscopy and histopathology, and the potential economic burden of treatment. Intestinal TB also represents a significant confounding factor in the diagnosis of IBD in Africa.

1171 National Burden of Gastrointestinal Tuberculosis: Insights From the Nationwide Inpatient Sample

INTRODUCTION: Gastrointestinal tuberculosis (GI TB) is a rare and morbid extrapulmonary manifestation of TB. There is scant published data regarding the prevalence of GI TB. ThE aim of our study was to assess the overall burden of inpatient GI TB in the United States. We also looked at demographic characteristics, comorbidities and all-cause inpatient mortality among patients with GI TB. METHODS: All adults hospitalized with the diagnosis of either gastric TB or intestinal TB or both, during the years 2010 to 2014, were identified using the Nationwide Inpatient Sample (NIS). Patients with tuberculous associated peritonitis were also included. We studied racial, regional and gender-specific characteristics of these patients. Other demographic data such as risk factors and comorbidities were also identified. Outcomes of interest included inpatient mortality and length of stay. RESULTS: During the five-year study period, there were a total of 2,300 inpatient hospital admissions for GI TB. We observed a downward trend in the prevalence of GI TB in the US during this time (469 vs 340 vs 380 vs 329 vs 78; P = 0.56) (Figure 1). Patients affected were predominantly Hispanic (36.04% vs 53.99% vs 24.78% vs 30.17%; P = 0.002) in all four regions. Several other comorbidities and conditions were identified as enlisted in Table 1. The overall inpatient mortality (6.25% vs 1.20% vs 2.61% vs 3.24%; P = 0.206) and mean length of stay (18.11 vs 9.07 vs 10.56 vs 14.57 days; P = 0.001) were highest in the NE region as compared to MW, SO and WE regions. In addition, hospitalized patients with GI TB were less likely to be female in Northeastern (NE) states (30.91% vs 56.29% vs 51.64% vs 50.64%; P = 0.05) as compared to Midwest (MW), Southern (SO) and Western (WE) states. CONCLUSION: Since the introduction of antituberculous therapy, the global and national overall burden of GI TB has decreased significantly. It is, however, important to note that although rare, GI TB continue to affect high-risk patient populations such as immigrants, prisoners, HIV patients and patients who are immunocompromised from receiving various biologic agents for treatment of several autoimmune diseases. Our study shows that although prevalent, overall inpatient admissions associated with GI TB have been decreasing over the last few years; however they are associated with high mortality. Our study highlights continued prevalence of GI TB amongst inpatients in the US, and emphasizes the importance of clinical suspicion when evaluating high risk patients.