Intestinal Tuberculosis Research Articles

High Accuracy of a Simplified, Practical Algorithm in Differentiating Crohn’s Disease from Intestinal Tuberculosis

Background: The differentiation between intestinal tuberculosis (ITB) and Crohn’s disease (CD) remains a challenge, particularly in areas where tuberculosis is highly prevalent. Previous studies have identified features that favour one diagnosis over the other. The aim of the study was to determine the accuracy of a standardized protocol in the initial diagnosis of CD versus ITB. Methods: All patients with suspected ITB or CD were prospectively recruited. A standardized protocol was applied, and the diagnosis was made accordingly. The protocol consists of history and examination, ileocolonoscopy with biopsies, and tuberculosis workup. The diagnosis of probable ITB was made based on at least one positive finding. All other patients were diagnosed as probable CD. Patients were treated either with anti-tubercular therapy or steroids. Reassessment was then carried out clinically, biochemically, and endoscopically. In patients with suboptimal response, the treatment was either switched or escalated depending on the reassessment. Results: 164 patients were recruited with final diagnosis of 30 (18.3%) ITB and 134 (81.7%) CD. 1 (3.3%) out of 30 patients with ITB was initially treated as CD. 16 (11.9%) out of 134 patients with CD were initially treated as ITB. The initial overall accuracy for the protocol was 147/164 (89.6%). All patients received the correct diagnosis by 12 weeks after reassessment. Conclusion: In our population, most patients had CD rather than ITB. The standardized protocol had a high accuracy in differentiating CD from ITB.

Spectrum of abdominal tuberculosis presenting as acute surgical emergency: Relevance in 21st century, a case series

BackgroundAbdominal tuberculosis presenting as acute surgical emergency continues to be a major issue in developing countries including India. Being an indolent disease with varied presentation, there is a need to describe the epidemiology, clinicopathological nature of the disease. Hence, this series was conducted with the aim of describing our institutional experience in the management of abdominal tuberculosis presenting as acute surgical emergency, outlining the epidemiology, management aspects and the analysis of risk factors for poor outcome in our population. MethodsThis was a descriptive series of patients operated for abdominal tuberculosis presenting as acute surgical emergency at a tertiary care hospital in Eastern India from January 2021 to January 2022. All consecutive patients presenting with intestinal obstruction or peritonitis who underwent laparotomy with intra operative and histopathological finding suggestive of tuberculosis were taken for the study. ResultsA total of 30 patients with acute abdominal tuberculosis were included in the study. 56.7% of patients were males; the mean age of presentation was 43 years with majority of patients in the younger to middle age groups. Most (80%) patients were from rural areas with limited access to healthcare. One patient had co-infection with HIV. Five patients had diabetes and six patients had hypertension as co-morbidities. 73.3% of patients had primary intestinal tuberculosis. Majority (76.7%) presented with acute intestinal obstruction. All patients had colicky abdominal pain as a consistent feature. 40% of patients were anaemic and 70% had low serum albumin levels. The most common site of affection was Ileo-cecal region (73.3%) with stricture as the pathology. Segmental resection with end to end anastomosis was the most common procedure performed (46.7%). 26.7% of patients had an adverse post operative complication, and 23.3% had surgical site infection (SSI). The mortality rate in our series was 6.7%. Although coexisting SSI, co-morbidities were associated with increased mortality, it was not found to be statistically significant (p = 0.08). 16 patients were lost to follow up. ConclusionAbdominal tuberculosis presenting as acute abdomen continues to challenge surgeons even in the 21st century. Majority in the developing countries present late with varied complications. A high index of clinical suspicion is required for timely diagnosis to reduce the mortality and morbidity of the disease.

Clinical Analysis of Intestinal Tuberculosis: A Retrospective Study.

This study aimed to summarize and analyze the clinical data of intestinal tuberculosis (ITB) in order to provide guidance for accurate diagnosis and treatment of ITB. This study consecutively included patients with ITB who were admitted to our hospital from 2008 to 2021 and retrospectively analyzed their clinical features. Forty-six patients were included. The most common clinical symptom was weight loss (67.4%). Seventy percent of 20 patients were positive for tuberculin skin test; 57.1% of 14 patients were positive for mycobacterium tuberculosis specific cellular immune response test, while 84.6% of 26 patients were positive for tuberculosis infection T cell spot test. By chest computed tomography (CT) examination, 25% and 5.6% of 36 patients were diagnosed with active pulmonary tuberculosis and with inactive pulmonary tuberculosis, respectively. By abdominal CT examination, the most common sign was abdominal lymph node enlargement (43.2%). Forty-two patients underwent colonoscopy, and the most common endoscopic manifestation was ileocecal ulcer (59.5%), followed by colonic ulcer (35.7%) and ileocecal valve deformity (26.2%). ITB most frequently involved the terminal ileum/ileocecal region (76.1%). Granulomatous inflammation with multinucleated giant cells and caseous necrosis was found via endoscopic biopsies, the ultrasound-guided percutaneous biopsy of enlarged mesentery lymph nodes, and surgical interventions. The acid-fast bacilli were discovered in 53.1% of 32 samples. Twenty-one cases highly suspected of ITB were confirmed after responding to empiric anti-tuberculosis therapy. It was necessary to comprehensively analyze clinical features to make an accurate diagnosis of ITB and aid in distinguishing ITB from diseases such as Crohn's disease and malignant tumors.

Risk Prediction Model for Crohn's Disease Based on Hematological Indicators.

The similarity between Crohn's disease (CD) and non-CD, especially with ulcerative colitis (UC) or intestinal tuberculosis (ITB), makes the diagnostic error rate not low. Therefore, there is an urgent need for an efficient, fast, and simple predictive model that can be applied in clinical practice. The purpose of this study is to establish the risk prediction model for CD based on five routine laboratory tests by logistic-regression algorithm, to construct the early warning model for CD and the corresponding visual nomograph, and to provide an accurate and convenient reference for the risk determination and differential diagnosis of CD, in order to assist clinicians to better manage CD and reduce patient suffering. Using a retrospective analysis, a total of 310 cases were collected from 2020 to 2022 at The Sixth Affiliated Hospital, Sun Yat-sen University, who were diagnosed by comprehensive clinical diagnosis, including 100 patients with CD, 50 patients with ulcerative colitis (UC), 110 patients with non-inflammatory bowel disease (non-IBD) diseases (65 cases of intestinal tuberculosis, radioactive enterocolitis 39, and colonic diverticulitis 6), and 50 healthy individuals (NC) in the non-CD group. Risk prediction models were established by measuring ESR, Hb, WBC, ALb, and CH levels in hematology. The models were evaluated and visualized using logistic-regression algorithm. 1) ESR, WBC, and WBC/CH ratios in the CD group were higher than those in the non-CD group, while ALb, Hb, CH, WBC/ESR ratio, and Hb/WBC ratio were lower than those in the non-CD group, and the differences were statistically significant (all p < 0.05). 2) CD occurrence had a strong correlation with the WBC/CH ratio, with the correlation coefficient exceeding 0.4; CD occurrence was correlated with other indicators. 3) A risk prediction model containing age, gender, ESR, ALb, Hb, CH, WBC, WBC/CH, WBC/ESR, and Hb/WBC characteristics was constructed using a logistic-regression algorithm. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve of the model were 83.0%, 76.2%, 59.0%, 90.5%, and 0.86, respectively. The model based on the corresponding index also had high diagnostic accuracy (AUC = 0.88) for differentiating CD from ITB. Visual nomograph based on the logistic-regression algorithm was also constructed for clinical application reference. In this study, a CD risk prediction model was established and visualized by five conventional hema-tological indices: ESR, Hb, WBC, ALb, and CH, in addition to a high diagnostic accuracy for the differential diagnosis of CD and ITB.

Intestinal tuberculosis can masquerade as Crohn’s disease: A teachable moment

Intestinal tuberculosis and Crohn’s disease are chronic granulomatous diseases with similar clinical presentations and can mimic one another. Their treatment modalities are completely different; however, sometimes it is challenging to differentiate them. We report a case of a 51-year-old female presenting with abdominal pain and on-and-off diarrhea for 4 years with weight loss. Clinical symptoms along with multiple aphthous ulcers in the terminal ileum and negative tuberculin test favored the diagnosis of Crohn’s disease. The patient did not respond to steroids. A repeat colonoscopy with acid-fast bacilli stain showed Mycobacterium tuberculosis. This case highlights that acid-fast bacilli culture and tuberculosis polymerase chain reaction to confirm or rule out the diagnosis of intestinal tuberculosis in all patients suspected of Crohn’s disease.

Абдоминальный туберкулез у ребенка раннего возраста (клиническое наблюдение)

Abdominal tuberculosis is a specific tuberculous lesion of the abdominal organs. In children, abdominal tuberculosis is mostly secondary, occurring mainly in the form of mesadenitis and intestinal tuberculosis. In most cases (63–96%), the process is localized in the ileocecal valve. The article presents a case of untimely diagnosed abdominal tuberculosis with lymph node lesions of the peritoneum and intestines in a child with intrathoracic lymph node tuberculosis of all groups during densification and the calcification onset. The examination (computed tomography) revealed a lesion of the ileocecal valve, while histology of biopsy material taken during colonoscopy showed granulomatous colitis of mycobacterial nature. The leading clinical manifestation was malabsorption syndrome with increased protein-energy undernutrition. The disease pattern was the rare localization of a specific lesion — in the small intestine with the development of jejunal stenosis, which led to a significant disorder of enteral nutrition and the development of malabsorption syndrome with severe trophological insufficiency. The decisive factor in determining the cause of the malabsorption syndrome was laparotomy, which was performed in presented signs of acute intestinal obstruction. In our opinion, an indication for diagnostic laparoscopy in children with abdominal tuberculosis should be considered the enteral nutrition disorder and malabsorption syndrome, which cannot be corrected at the therapeutic process stage. KEYWORDS: primary generalized tuberculosis, mycobacterium tuberculosis, intestinal tuberculosis, mesadenitis, malabsorption syndrome, jejunal stenosis, computed tomography, histology. FOR CITATION: Poddubnaya L.V., Dubakova G.F., Geleskul T.S., Shilova E.P., Kolpakova T.A., Osipenko M.F., Nikonov S.D., Drobysheva V.P. Abdominal tuberculosis in a baby (case report). Russian Medical Inquiry. 2023;7(5):337–342 (in Russ.). DOI: 10.32364/2587-6821-2023- 7-5-13.

Massive Gastrointestinal Bleeding as a clinical manifestation of Miliary Tuberculosis

Tuberculosis is still a public health problem today and can have acute and chronic manifestations challenging clinics for various medical specialties. Because it’s a disease of multisystem potential, it is often overlooked when outside the respiratory clinical context. As a result, a clinical case report was carried out at the Hospital de Clínicas de Porto Alegre, in 2020, of a patient with voluminous gastrointestinal bleeding as severe acute clinical manifestation of Miliary and Intestinal Tuberculosis. Due to the potential severity of undiagnosed and untreated tuberculosis, high suspicion is suggested at all levels of health systems (whether public or private) with a view to early diagnosis, treatment and prevention of complications resulting from the disease.

Диарейный синдром в практике врача-терапевта: алгоритм действий

According to the frequency of seeking medical care, diarrhea is one of the most common complaints, being an important health problem. Acute diarrhea, as a rule, is infectious in nature, thus, the scope of diagnostics is aimed at assessing the patient's condition and clarifying the pathogen etiology. Chronic diarrhea has a diverse etiology, which poses a difficult task for the clinician to conduct differential diagnosis. Therefore, most guidelines on the relevant problem suggest the use of medical algorithms aimed at step-by-step exclusion of diseases accompanied by diarrhea: from the most common causes to the more rare ones. First of all, it is necessary to detail complaints, identify the presence of red flags, collect an epidemiological, drug and hereditary history, assess the nutrition habits, dietary preferences of the patient and their possible association with the manifestation of diarrhea. The general examination reveals signs of dehydration and malabsorption, as well as the presence of stigma of the underlying disease. Also, at the first stage, it is advisable to conduct the minimum necessary laboratory and instrumental studies. Subsequently, if there are difficulties in establishing the diagnosis, it is advised to re-assess the clinical picture and prescribe additional examination methods. Alongside this, symptomatic and pathogenetic therapy, dehydration, timely detection and correction of electrolyte disorders should be indicated for all patients with acute and chronic diarrhea at the stage of further examination and diagnosis confirmation. KEYWORDS: acute diarrhea, chronic diarrhea, diagnostic algorithm, celiac disease, intestinal tuberculosis, ischemic colitis, radiation colitis, eosinophilic colitis, microscopic colitis, Whipple disease. FOR CITATION: Livzan M.A., Gaus O.V., Gavrilenko D.A. Diarrheal syndrome in the practice of a general practitioner: medical algorithm. Russian Medical Inquiry. 2023;7(5):300–309 (in Russ.). DOI: 10.32364/2587-6821-2023-7-5-8.

Tubercular Meckel diverticulitis mimicking acute appendicitis

Meckel's diverticulum (MD) is usually silent and asymptomatic. Acute diverticulitis, perforation, intestinal obstruction, hemorrhage, and other complications are seen in &lt;4% of cases of MD. 27 year old female, presented with complaints of pain in her abdomen, clinically suspected of acute appendicitis, and finally diagnosed with tubercular Meckel diverticulitis. A clinical and laboratory diagnosis of Meckel's diverticulitis is challenging as it mimics appendicitis and is generally observed during surgical procedures. Meckel's diverticulitis should be suspected and explored, especially when the appendix appears normal in an acute abdomen. The presence of intestinal tuberculosis (TB) in unusual locations should be closely monitored, particularly in countries where TB is endemic.

Actinomycosis Simulating Malignancy on CT: A Case of A Long-Forgotten IUD

Actinomyces Israelii is known to be commensal, particularly in the gums and tonsils, sometimes in the vagina. The diagnosis of actinomycosis is challenging owing to nonspecific clinical findings. First instance imaging often resembles inflammatory and infective pathologies like Crohn’s or intestinal tuberculosis, and in this case, abdominal malignancies [1]. Actinomycosis infectionsare complicated by their tendency to extend into surrounding structures and develop fistulae [2]. Our case report specifically looks at a fit-and-well female patient who had been referred under a suspected gastrointestinal cancer pathway after a recent change in bowel habit for CT imaging which was subsequently thought to be disseminative malignant growths. Our 56-year-old lady had an indurating mass in her abdomen draining pus which prompted her GP to discuss this case with the surgeons. On further MRI imaging and lab cultures, it was revealed that the sinister mass is found to be an Actinomyces Israelii colonised long-forgotten IUD placed 12 years ago. The unfortunate patient suffered widespread abdominal involvement which required extensive surgery involving major bowel resection, salpingo-oopherectomy, bilateral ureteric stents for hydronephrosis and a partial cystectomy.

Trends of Indications and Complications of Stoma in a Tertiary Care Hospital

Objective: To identify the indications and complications of the stoma. Methods: The study covered all patients who attended Outpatients department of General Surgery, Ziauddin Hospital in Karachi and met the inclusion criteria. After describing the study's process, hazards, and benefits, informed permission was obtained. The patients were followed after 4 weeks in the clinic and assessed for Indications (enteric perforation, intestinal tuberculosis, penetrating injury, intestinal obstruction, blunt abdominal trauma). Complications (excoriation, non-functioning stoma, retraction, prolapsed, stenosis of Stomas, wound infection). The proforma that is supplied at the end was filled out with all the acquired data and utilised electronically for research. Results: The mean age of patients was 38.5 ± 7.4 years and the body mass index was 26.8 ± 6.2 kg/m2. The most common indication for stoma was intestinal tuberculosis (41.0%) followed by enteric perforation (27%). The most common complications of stoma were non-functioning stoma (34.4%) followed by excoriation (23.9%). Stoma indication due to enteric perforation was significantly more common in patients aged between 16 and 40 years (p=0.003). Other indications were not significantly associated with age, BMI, and age. The rate of excoriation was 52 (20.1%) in patients with BMI of more than 24 kg/m2 which is significantly higher as compared to patients with lower BMI (p=0.029). The other complications were not significantly different between the age groups, BMI categories, and gender. Conclusion: The most frequent indications and consequences, respectively, were determined to be non-functioning stomas and intestinal tuberculosis. Reduced stoma development and related problems can be achieved with early detection and treatment of TB and enteric fever. Keywords: Indications, Complications, Stoma, Management, Intestinal Stoma, Ostomy, Colostomy

Epidemiology of extrapulmonary tuberculosis in central Guangxi from 2016 to 2021.

The burden of extrapulmonary tuberculosis (EPTB) has gradually increased in recent years, but not enough epidemiological data is available from central Guangxi. To better understand the epidemiology of EPTB in central Guangxi and identify risk factors associated with them, we retrospectively investigated the epidemiology of tuberculosis (TB), especially EPTB, among patients admitted to the Chest Hospital of Guangxi Zhuang Autonomous Region between 2016 and 2021. We excluded those infected with both pulmonary tuberculosis (PTB) and EPTB, reported the proportion and incidence of PTB or EPTB, and compared the demographic characteristics and risk factors of EPTB and PTB cases using univariate and multivariate logistic regression models. Among 30,893TB patients, 67.25% (20,774) had PTB and 32.75% (10,119) had EPTB. Among EPTB, pleural, skeletal, lymphatic, pericardial, meningeal, genitourinary, intestinal, and peritoneal TB accounted for 49.44%, 27.20%, 8.55%, 4.39%, 3.36%, 1.48%, 0.87%, and 0.79%, respectively. Patients who were younger (age < 25), from rural areas, Zhuang and other ethnic groups, and diagnosed with anemia and HIV infection were more likely to develop EPTB. However, patients with diabetes and COPD were less likely to have EPTB. From 2016 to 2021, the proportion of PTB cases decreased from 69.73 to 64.07%. The percentage of EPTB cases increased from 30.27 to 35.93%, with the largest increase in skeletal TB from 21.48 to 34.13%. The epidemiology and risk factors of EPTB in central Guangxi are different from those of PTB. The incidence of EPTB is increasing and further studies are needed to determine the reasons for it.

Differential diagnosis of Crohn’s disease and intestinal tuberculosis: development and assessment of a nomogram prediction model

BackgroundChina is a region with a high incidence of tuberculosis, and the incidence of IBD has also been rising rapidly in recent years. Differentiating Crohn’s disease(CD) from intestinal tuberculosis (ITB) has become a very challenging issue. We aimed to develop and assess a diagnostic nomogram to differentiate between CD and ITB to improve the accuracy and practicability of the model.MethodsA total of 133 patients (CD 90 and ITB 43) were analyzed retrospectively. Univariate and multivariate logistic regression analysis was included to determine the independent predictive factors and establish the regression equation. On this basis, the nomogram prediction model was constructed. The discrimination, calibration and clinical efficiency of the nomogram were assessed using area under the curve(AUC), C-index, calibration curve, decision curve analysis (DCA) and clinical impact curve.ResultsT-SPOT positive, cobblestone appearance, comb sign and granuloma were significant predictors in differentiating CD from ITB. Base on the above independent predictors, a diagnostic nomogram was successfully established. The sensitivity, specificity, accuracy of the prediction model are 94.4%, 93.0%, 94.0% respectively. The AUC and the C-index of the prediction model are both 0.988, which suggest that the model had a good discrimination power. The calibration curve indicated a high calibration degree of the prediction model. The DCA and clinical impact curve indicated a good clinical efficiency of the prediction model which could bring clinical benefits.ConclusionA nomogram prediction model for distinguishing CD from ITB was developed and assessed, with high discrimination, calibration and clinical efficiency. It can be used as an accurate and convenient diagnostic tool to distinguish CD from ITB, facilitating clinical decision-making.

Immunological Interactions between Intestinal Helminth Infections and Tuberculosis.

Helminth infections are among the neglected tropical diseases affecting billions of people globally, predominantly in developing countries. Helminths' effects are augmented by coincident tuberculosis disease, which infects a third of the world's population. The role of helminth infections on the pathogenesis and pathology of active tuberculosis (T.B.) remains controversial. Parasite-induced suppression of the efficacy of Bacille Calmette-Guerin (BCG) has been widely reported in helminth-endemic areas worldwide. T.B. immune response is predominantly proinflammatory T-helper type 1 (Th1)-dependent. On the other hand, helminth infections induce an opposing anti-inflammatory Th2 and Th3 immune-regulatory response. This review summarizes the literature focusing on host immune response profiles during single-helminth, T.B. and dual infections. It also aims to necessitate investigations into the complexity of immunity in helminth/T.B. coinfected patients since the research data are limited and contradictory. Helminths overlap geographically with T.B., particularly in Sub-Saharan Africa. Each disease elicits a response which may skew the immune responses. However, these effects are helminth species-dependent, where some parasites have no impact on the immune responses to concurrent T.B. The implications for the complex immunological interactions that occur during coinfection are highlighted to inform government treatment policies and encourage the development of high-efficacy T.B. vaccines in areas where helminths are prevalent.

Electroacupuncture vs Sham Electroacupuncture in the Treatment of Postoperative Ileus After Laparoscopic Surgery for Colorectal Cancer

Despite the adoption of the optimized Enhanced Recovery After Surgery (ERAS) protocol, postoperative ileus (POI) severely impairs recovery after colorectal resection and increases the burden on the health care system. To assess the efficacy of electroacupuncture (EA) in reducing the duration of POI with the ERAS protocol. This multicenter, randomized, sham-controlled trial was conducted in China from October 12, 2020, through October 17, 2021. There was a 1:1 allocation using the dynamic block random method, and analyses were by intention to treat. Patients 18 years or older undergoing laparoscopic resection of colorectal cancer for the first time were randomly assigned to treatment group by a central system. Patients were randomly assigned to 4 sessions of EA or sham electroacupuncture (SA) after surgery. All patients were treated within the ERAS protocol. The primary outcome was the time to first defecation. Secondary outcomes included other patient-reported outcome measures, length of postoperative hospital stay, readmission rate within 30 days, and incidence of postoperative complications and adverse events. A total of 249 patients were randomly assigned to treatment groups. After the exclusion of 1 patient because of a diagnosis of intestinal tuberculosis, 248 patients (mean [SD] age, 60.2 [11.4] years; 153 men [61.7%]) were included in the analyses. The median (IQR) time to first defecation was 76.4 (67.6-96.8) hours in the EA group and 90.0 (73.6-100.3) hours in the SA group (mean difference, -8.76; 95% CI, -15.80 to -1.73; P = .003). In the EA group compared with the SA group, the time to first flatus (median [IQR], 44.3 [37.0-58.2] hours vs 58.9 [48.2-67.4] hours; P < .001) and the tolerability of semiliquid diet (median [IQR], 105.8 [87.0-120.3] hours vs 116.5 [92.0-137.0] hours; P = .01) and solid food (median [IQR], 181.8 [149.5-211.4] hours vs 190.3 [165.0-228.5] hours; P = .01) were significantly decreased. Prolonged POI occurred in 13 of 125 patients (10%) in the EA group vs 25 of 123 patients (20%) in the SA group (risk ratio [RR], 0.51; 95% CI, 0.27-0.95; P = .03). Other secondary outcomes were not different between groups. There were no severe adverse events. Results of this randomized clinical trial demonstrated that in patients undergoing laparoscopic surgery for colorectal cancer with the ERAS protocol, EA shortened the duration of POI and decreased the risk for prolonged POI compared with SA. EA may be considered as an adjunct to the ERAS protocol to promote gastrointestinal function recovery and prevent prolonged POI after surgery. Chinese Clinical Trial Registry Identifier: ChiCTR2000038444.

Current role of endoscopic ultrasound for gastrointestinal and abdominal tuberculosis

A high incidence of tuberculosis (TB), especially in endemic countries, makes this infectious disease a concern. Abdominal TB contributes to 10% of extrapulmonary TB. Due to nonspecific clinical, radiological, and endoscopic findings, diagnosing abdominal TB continues to be a challenge. Hence, a precise diagnosis is needed. The diagnosis of gastrointestinal disease using endoscopic ultrasound (EUS) is often performed due to its high resolution and ability to provide a real-time visual representation of the gastrointestinal tract and extramural structures. EUS-guided fine-needle aspiration (FNA) and fine-needle biopsy (FNB) have helped diagnose TB as they offer an adequate specimen for cytology or histopathological examination. This method is considered safer, more effective, and more efficient. The capacity of EUS to diagnose abdominal TB based on the affected organs was examined via a literature search. We reviewed the role of EUS in diagnosing esophageal, gastric, pancreatic, peripancreatic, hepatosplenic, peritoneal, and intestinal TB. Generally, EUS aids in diagnosing abdominal TB. In some organs, it is superior to other diagnostic modalities. However, further examinations, such as cytology or histopathology and microbial, are still needed. We also studied the roles of EUS-FNA and EUS-FNB. EUS-FNA has shown a high diagnostic yield in esophageal (94.3-100%), pancreatic and peripancreatic (76.2%), and intestinal TB (84.1%). As minimally invasive methods, EUS-FNA and EUS-FNB can successfully provide sufficient samples. EUS is a functional diagnostic modality for abdominal TB. EUS-FNA and EUS-FNB provide sufficient samples safely and efficiently for further cytology, histopathology, and microbial examinations.

The efficacy of mesalazine on nonspecific terminal ileal ulcers: A randomized controlled trial.

Background: Nonspecific terminal ileal ulcers are one of the common ulcerative diseases in terminal ileum. However, the studies about treatment efficacy are scarce. We aimed to investigate the efficacy of mesalazine in the treatment of this disease. Methods: Eighty-two patients with nonspecific terminal ileal ulcers who sought outpatient medical treatment in the Division of Gastroenterology, Wuhan Union Hospital, from April 2016 to January 2019 were enrolled and randomly divided into two groups. The experimental group took mesalazine orally, 4.0 g/d, once a day for 3 months. The control group was followed up without special intervention. The primary endpoint was the endoscopic remission rate at the 6th and 12th month. Secondary endpoints included the clinical remission rate at the 1st, 6th and 12th month and adverse events (ChiCTR1900027503). Results: About the endoscopic efficacy, the remission rate of the experimental group and control group was 73.2 versus 61.0% at the 6th month (RR = 1.20, 95%CI 0.88∼1.63, p = 0.24) and 87.8 versus 78.0% at the 12th month (RR = 1.13, 95%CI 0.92∼1.37, p = 0.24). About the clinical efficacy, the remission rate was 70.3 versus 43.8% at the 1st month (RR = 1.61, 95%CI 1.03∼2.51, p = 0.03), 83.8 versus 68.8% at the 6th month (RR = 1.22, 95%CI 0.93∼1.60, p = 0.14) and 91.9 versus 81.3% at the 12th month (RR = 1.13, 95%CI 0.93∼1.37, p = 0.34). During follow-up, no patients were diagnosed with Crohn’s disease or intestinal tuberculosis, and no patients developed significant complications. Conclusion: For patients with nonspecific terminal ileal ulcers, there is no disease progression over a short term. In addition, there is no significant difference in clinical or endoscopic efficacy between patients who received mesalazine and patients who are followed up without special intervention.

Double troubleStrongyloidiasis hyper infection and intestinal tuberculosis co-infection-A rare case report

Strongyloidiasis, a human intestinal parasitic infection is most commonly caused by Strongyloides stercoralis species. Strongyloides Hyperinfection is an accelerated autoinfection occurring in immunocompromised state like tuberculosis, where increased number of infectious filariform larvae are produced. Here, we report a case of 35-year-old male, known case of intestinal tuberculosis, presenting with complaints of pain abdomen, associated with vomiting. Clinical and radiological examination revealed hollow viscous perforation with peritonitis. Surgical ileal resection with anastomosis was performed and histopathological analysis of the specimen revealed eggs and larval and adult forms of Strongyloides stercoralis within crypts and superficial mucosa

Diagnostic predicaments in a case of Intestinal obstruction with strictures to distinguish intestinal Koch’s and Crohn’s disease

Intestinal Tuberculosis (Koch’s) has become a very common disease which pose a great diagnostic challenge because of its non- specific presentation and broad-spectrum features and lead to delays in diagnosis along with developments of complications. This 70 years old female patient presented with intestinal obstruction with multiple strictures. It was very tough to distinguish Tuberculosis from Crohn’s Disease in this case as the sections for histology were continuously negative for Acid fast bacilli. This case demonstrates the diagnostic predicaments encountered to arrive at a diagnosis of Intestinal Tuberculosis.

Indication, Location of the Lesion, Diagnostic Yield, and Therapeutic Yield of Double-Balloon Enteroscopy: Seventeen Years of Experience.

Double-balloon enteroscopy (DBE) has become one of the standard methods in the diagnosis and treatment of small bowel (SB) disease. However, previous studies for DBE have limitations due to heterogeneity of indications and operators. The aim was to investigate the indication, location of the lesion, diagnostic yield, and therapeutic yield of DBE based on long-term data from a single operator. A retrospective study was performed by reviewing medical records of subjects who had received DBE at our unit in the past 17 years. Overall diagnostic yield was 78.7% (210/267). The diagnostic yield for obscure gastrointestinal bleeding (OGIB) was 68.3% (84/123). The diagnostic yield for OGIB was significantly lower (p < 0.001) than that for other indications. Therapeutic yield was 24.7% (66/267). Complications occurred in 7 (2.6%). Crohn’s disease, intestinal tuberculosis, nonsteroidal anti-inflammatory drug enteropathy, and diverticular lesions were mainly found in the ileum. Vascular lesions, non-specific inflammation, and neoplastic lesions were found more frequently in the jejunum. DBE is an excellent and safe endoscopic method for the diagnosis and treatment of SB lesions. DBE has a lower diagnostic rate for OGIB than for other indications. The location where a lesion is commonly found depends on the type of the lesion.