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Pathak P, Sharma V. Stricturing Crohn's disease-Gastrointestinal tuberculosis as an important differential. Indian J Gastroenterol 2024:10.1007/s12664-024-01616-z. [PMID: 38814493 DOI: 10.1007/s12664-024-01616-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Affiliation(s)
- Parna Pathak
- Kasturba Medical College, Manipal, 576 104, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
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2
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Hashiba T, Sugahara M, Ota Y, Kaseda K, Kashiwagi Y, Nakamura M, Shinohara T, Ikeda M, Okugawa S, Sugimoto K, Sasaki K, Hamasaki Y, Yamada D, Kume H, Moriya K, Nangaku M. Paralytic Ileus during Treatment of Pulmonary and Renal Tuberculosis in a Non-Human Immunodeficiency Virus Patient: An Unusual Presentation of Tuberculosis-immune Reconstitution Inflammatory Syndrome. Intern Med 2023; 62:2559-2564. [PMID: 36642517 PMCID: PMC10518560 DOI: 10.2169/internalmedicine.0898-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/29/2022] [Indexed: 01/15/2023] Open
Abstract
Paralytic ileus as tuberculosis-immune reconstitution inflammatory syndrome (TB-IRIS) is extremely rare. We herein report a 44-year-old man with pulmonary and renal tuberculosis who developed paralytic ileus 14 days after starting antituberculosis therapy (ATT) despite an initial favorable response to ATT. Paralytic ileus was successfully managed with conservative care. He initially required hemodialysis because of obstructive uropathy due to renal tuberculosis, but he was able to withdraw from dialysis after placement of ureteral stents. TB-IRIS can affect organs other than the original sites of tuberculosis, and the combined use of steroids may be effective for its prevention and treatment.
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Affiliation(s)
- Toyohiro Hashiba
- Division of Nephrology and Endocrinology, the University of Tokyo Hospital, Japan
| | - Mai Sugahara
- Division of Nephrology and Endocrinology, the University of Tokyo Hospital, Japan
| | - Yui Ota
- Division of Nephrology and Endocrinology, the University of Tokyo Hospital, Japan
| | - Ken Kaseda
- Division of Nephrology and Endocrinology, the University of Tokyo Hospital, Japan
| | - Yusuke Kashiwagi
- Division of Nephrology and Endocrinology, the University of Tokyo Hospital, Japan
| | - Motonobu Nakamura
- Division of Nephrology and Endocrinology, the University of Tokyo Hospital, Japan
| | - Takayuki Shinohara
- Department of Infectious Diseases, the University of Tokyo Hospital, Japan
| | - Mahoko Ikeda
- Department of Infectious Diseases, the University of Tokyo Hospital, Japan
| | - Shu Okugawa
- Department of Infectious Diseases, the University of Tokyo Hospital, Japan
| | - Kazuma Sugimoto
- Department of Urology, the University of Tokyo Hospital, Japan
| | - Kenichi Sasaki
- Department of Urology, the University of Tokyo Hospital, Japan
| | - Yoshifumi Hamasaki
- Department of Hemodialysis & Apheresis, the University of Tokyo Hospital, Japan
| | - Daisuke Yamada
- Department of Urology, the University of Tokyo Hospital, Japan
- Department of Hemodialysis & Apheresis, the University of Tokyo Hospital, Japan
| | - Haruki Kume
- Department of Urology, the University of Tokyo Hospital, Japan
| | - Kyoji Moriya
- Department of Infectious Diseases, the University of Tokyo Hospital, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, the University of Tokyo Hospital, Japan
- Department of Hemodialysis & Apheresis, the University of Tokyo Hospital, Japan
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Jena A, Mohindra R, Rana K, Neelam PB, Thakur DC, Singh H, Gupta P, Suri V, Sharma V. Frequency, outcomes, and need for intervention in stricturing gastrointestinal tuberculosis: a systematic review and meta-analysis. BMC Gastroenterol 2023; 23:46. [PMID: 36814249 PMCID: PMC9948355 DOI: 10.1186/s12876-023-02682-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Gastrointestinal strictures impact clinical presentation in abdominal tuberculosis and are associated with significant morbidity. AIM To conduct a systematic review of the prevalence of stricturing disease in abdominal and gastrointestinal tuberculosis and response to antitubercular therapy (ATT). METHODS We searched Pubmed and Embase on 13th January 2022, for papers reporting on the frequency and outcomes of stricturing gastrointestinal tuberculosis. The data were extracted, and pooled prevalence of stricturing disease was estimated in abdominal tuberculosis and gastrointestinal (intestinal) tuberculosis. The pooled clinical response and stricture resolution (endoscopic or radiologic) rates were also estimated. Publication bias was assessed using the Funnel plot and Egger test. The risk of bias assessment was done using a modified Newcastle Ottawa Scale. RESULTS Thirty-three studies reporting about 1969 patients were included. The pooled prevalence of intestinal strictures in abdominal tuberculosis and gastrointestinal TB was 0.12 (95%CI 0.07-0.20, I2 = 89%) and 0.27 (95% CI 0.21-0.33, I2 = 85%), respectively. The pooled clinical response of stricturing gastrointestinal tuberculosis to antitubercular therapy was 0.77 (95%CI 0.65-0.86, I2 = 74%). The pooled stricture response rate (endoscopic or radiological) was 0.66 (95%CI 0.40-0.85, I2 = 91%). The pooled rate of need for surgical intervention was 0.21 (95%CI 0.13-0.32, I2 = 70%), while endoscopic dilatation was 0.14 (95%CI 0.09-0.21, I2 = 0%). CONCLUSION Stricturing gastrointestinal tuberculosis occurs in around a quarter of patients with gastrointestinal tuberculosis, and around two-thirds of patients have a clinical response with antitubercular therapy. A subset of patients may need endoscopic or surgical intervention. The estimates for the pooled prevalence of stricturing disease and response to ATT had significant heterogeneity.
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Affiliation(s)
- Anuraag Jena
- grid.415131.30000 0004 1767 2903Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Ritin Mohindra
- grid.415131.30000 0004 1767 2903Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Kirtan Rana
- grid.415131.30000 0004 1767 2903Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Pardhu B. Neelam
- grid.415131.30000 0004 1767 2903Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Dhuni Chand Thakur
- grid.415131.30000 0004 1767 2903Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Harjeet Singh
- grid.415131.30000 0004 1767 2903Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Pankaj Gupta
- grid.415131.30000 0004 1767 2903Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Vikas Suri
- grid.415131.30000 0004 1767 2903Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Kumar P, Jena A, Birda CL, Singh H, Gupta P, Prasad KK, Dutta U, Sharma V. Safety and efficacy of non-fluoroscopic endoscopic dilatation of gastrointestinal tuberculosis related strictures. BMC Gastroenterol 2022; 22:60. [PMID: 35148672 PMCID: PMC8832754 DOI: 10.1186/s12876-022-02140-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 02/04/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Stricturing gastrointestinal tuberculosis (GITB) may result in persistent symptoms even after antitubercular therapy (ATT) and may require surgical intervention. Data on efficacy and safety of endoscopic dilatation for management GITB related strictures is scarce. Methods A retrospective analysis of database of patients who underwent endoscopic balloon dilatation for suspected or proven gastrointestinal tuberculosis was performed. The analysis included the site of involvement, technical success, clinical success (response), relapse and requirement of surgery in these patients. Results Out of 34 patients (47.1% males, mean age 31.9 ± 12.9 years), eventually four patients were diagnosed to have Crohn’s disease while the rest had GITB. Initial technical success was achieved in 30 (88.2%) patients. Initial clinical success was achieved in 28 (82.3%) patients. Median number of dilatation sessions required to obtain symptomatic relief were 2.5 (1–5) per patient. Two patients with initial clinical success had recurrence of symptoms over follow up of 1 year, out of which one patient was managed with repeat endoscopic balloon dilatation successfully. Of 30 patients with technical success, 16 (53.4%) were on ATT when they underwent dilatation while two were in intestinal obstruction. Eventually 7 patients required surgical intervention for various reasons. Conclusion Non-fluoroscopic endoscopic balloon dilatation is an acceptable and fairly safe modality for symptomatic tuberculous strictures of gastrointestinal tract.
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Affiliation(s)
- Pankaj Kumar
- Departments of Gastroenterology, Gastrointestinal Surgery and Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anuraag Jena
- Departments of Gastroenterology, Gastrointestinal Surgery and Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Chhagan Lal Birda
- Departments of Gastroenterology, Gastrointestinal Surgery and Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Harjeet Singh
- Departments of Gastroenterology, Gastrointestinal Surgery and Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pankaj Gupta
- Departments of Gastroenterology, Gastrointestinal Surgery and Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kaushal Kishor Prasad
- Departments of Gastroenterology, Gastrointestinal Surgery and Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Usha Dutta
- Departments of Gastroenterology, Gastrointestinal Surgery and Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishal Sharma
- Departments of Gastroenterology, Gastrointestinal Surgery and Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Hokama A, Oishi Y, Koga E, Takehara S, Fujita J. Paradoxical Reaction to Antitubercular Treatment Causing Colonic Obstruction. Chonnam Med J 2022; 58:52-53. [PMID: 35169562 PMCID: PMC8813645 DOI: 10.4068/cmj.2022.58.1.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- Akira Hokama
- Department of Endoscopy, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yuiko Oishi
- Department of Endoscopy, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Erika Koga
- Department of Endoscopy, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Sayuri Takehara
- Department of Endoscopy, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Jiro Fujita
- Department of Infectious, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Al-Zanbagi AB, Shariff MK. Gastrointestinal tuberculosis: A systematic review of epidemiology, presentation, diagnosis and treatment. Saudi J Gastroenterol 2021; 27:261-274. [PMID: 34213424 PMCID: PMC8555774 DOI: 10.4103/sjg.sjg_148_21] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Tuberculosis (TB) once considered a disease of the developing world is infrequent in the developing world too. Its worldwide prevalence with a huge impact on the healthcare system both in economic and health terms has prompted the World Health Organization to make it a top priority infectious disease. Tuberculous infection of the pulmonary system is the most common form of this disease, however, extrapulmonary TB is being increasingly recognized and more often seen in immunocompromised situations. Gastrointestinal TB is a leading extrapulmonary TB manifestation that can defy diagnosis. Overlap of symptoms with other gastrointestinal diseases and limited accuracy of diagnostic tests demands more awareness of this disease. Untreated gastrointestinal TB can cause significant morbidity leading to prolonged hospitalization and surgery. Prompt diagnosis with early initiation of therapy can avoid this. This timely review discusses the epidemiology, risk factors, pathogenesis, clinical presentation, current diagnostic tools and therapy.
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Affiliation(s)
- Adnan B. Al-Zanbagi
- Department of Gastroenterology and Hepatology, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia
| | - M. K. Shariff
- Department of Gastroenterology and Hepatology, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia,Address for correspondence: Dr. M. K. Shariff, King Abdullah Medical City, PO Box 57657, Makkah Al Mukaramah - 21955, Kingdom of Saudi Arabia. E-mail:
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7
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Barot M, Yagnik VD, Patel K, Dawka S. Surgical management of abdominal tuberculosis: A prospective single-center study. Tzu Chi Med J 2020; 33:282-287. [PMID: 34386367 PMCID: PMC8323646 DOI: 10.4103/tcmj.tcmj_206_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/21/2020] [Accepted: 10/17/2020] [Indexed: 11/04/2022] Open
Abstract
Objective Tuberculosis (TB) can affect any part of the gastrointestinal tract. It is estimated that in 2018, 10 million people were affected with TB worldwide and there were 1.2 million TB deaths among human immunodeficiency virus-negative people. India has the highest TB burden in the world (27%), a significant proportion of which are of intestinal TB. The aims of this study were to assess clinical features and investigations for the diagnosis of abdominal TB and to analyze its various surgical manifestations and its management. Materials and Methods From October 1, 2014, to October 30, 2016, a total of 50 patients meeting the inclusion criteria for the study, age between 15 and 65 years and diagnosis of symptomatic intestinal TB requiring surgery, were enrolled in the study. We used descriptive statistics to analyze the data. Results Abdominal TB was most commonly seen in young adults. Intestinal obstruction was the most frequent presentation. The most common site of involvement in the present study was the ileum. Ultrasonography (USG) and X-ray were an integral part of the diagnosis, with computed tomography (CT) scan being rarely required. Although both anemia and erythrocyte sedimentation rate (ESR) are nonspecific, they may help in supporting the clinical and pathological findings. Most operations were elective, with intestinal obstruction being the most common indication and resection and end-to-end anastomosis performed most often. Histopathological examination was performed in all patients and showed caseating granuloma in 90% of cases, while 10% of cases had chronic noncaseating granulomas with ill-defined aggregates of epithelioid histiocytes. Conclusion Abdominal TB causes a significant problem in diagnosis due to nonspecific symptomatology and lack of specific laboratory tests. USG and X-ray were an integral part of the diagnosis. CT scan is rarely required. Although anemia and ESR are both nonspecific features, they may help in supporting the clinical and pathological findings. The most common site of involvement in the present study was the ileum. Intestinal obstruction was the most common indication for operation, with resection and end-to-end anastomosis being the most common operation. The mainstay of treatment is medical therapy and timely surgical intervention is required in a sizable number of patients.
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Affiliation(s)
- Mithun Barot
- Department of Surgery, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Vipul D Yagnik
- Department Surgical Gastroenterology, Nishtha Surgical Hospital and Research Centre, Patan, Gujarat, India
| | - Kirankumar Patel
- Department of Surgery, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Sushil Dawka
- Department of Surgery, SSR Medical College, Belle Rive, Mauritius
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8
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Gupta A, Pratap Mouli V, Mohta S, Kante B, Kalaivani M, Madhu D, Sahu P, Kumar S, Sharma R, Sahni P, Das P, Gupta SD, Makharia G, Kedia S, Ahuja V. Antitubercular Therapy Given to Differentiate Crohn's Disease From Intestinal Tuberculosis Predisposes to Stricture Formation. J Crohns Colitis 2020; 14:1611-1618. [PMID: 32369567 DOI: 10.1093/ecco-jcc/jjaa091] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Treatment trial with antitubercular therapy [ATT] is a common strategy in tuberculosis-endemic countries in case of a diagnostic dilemma between intestinal tuberculosis and Crohn's disease [CD]. Our aim was to determine the long-term clinical course of patients who received ATT before an eventual diagnosis of CD was made. METHODS We performed retrospective comparison between CD patients who received ≥6 months of ATT vs those who did not receive ATT. Outcomes assessed were change in disease behaviour during follow-up, requirement of surgery and medication use. RESULTS In all, 760 patients with CD were screened for the study and, after propensity matching for location and behaviour of disease, 79 patients in each group were compared. Progression from inflammatory [B1] to stricturing/fistulising [B2/B3] phenotype was increased among CD patients who received ATT [B1, B2, B3: 73.4%, 26.6%, 0% at baseline vs: 41.8%, 51.9%, 6.3% at follow-up, respectively] as compared with those who did not receive ATT [B1, B2, B3: 73.4%, 26.6%, 0% at baseline vs: 72.2%, 27.8%, 0% at follow-up, respectively] with an odds ratio of 11.05[3.17-38.56]. The usage of 5-aminosalocylates, steroids, immunosuppressants and anti-tumour necrosis factor was similar between both the groups. On survival analysis, CD patients who received ATT had a lower probability of remaining free of surgery [45%] than those who did not [76%] at 14 years of follow-up (hazard ratio [HR] = 3.22, 95% confidence interval [CI], 1.46-7.12, p = 0.004]. CONCLUSIONS Crohn's disease patients diagnosed after a trial with antitubercular therapy had an unfavourable long-term disease course with higher rate of stricture formation and less chance of remaining free of surgery.
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Affiliation(s)
- Akshita Gupta
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Venigalla Pratap Mouli
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Srikant Mohta
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Bhaskar Kante
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Madhu
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Pabitra Sahu
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Sudheer Kumar
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Peush Sahni
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Govind Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kedia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
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Ahamed Z R, Shah J, Agarwala R, Kumar-M P, Mandavdhare HS, Gupta P, Singh H, Sharma A, Dutta U, Sharma V. Controversies in classification of peritoneal tuberculosis and a proposal for clinico-radiological classification. Expert Rev Anti Infect Ther 2019; 17:547-555. [PMID: 31293195 DOI: 10.1080/14787210.2019.1642746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Rizwan Ahamed Z
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jimil Shah
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Roshan Agarwala
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harshal S Mandavdhare
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harjeet Singh
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ma L, Zhu Q, Li Y, Li W, Wang X, Liu W, Li J, Jiang Y. The potential role of CT enterography and gastrointestinal ultrasound in the evaluation of anti-tubercular therapy response of intestinal tuberculosis: a retrospective study. BMC Gastroenterol 2019; 19:106. [PMID: 31242849 PMCID: PMC6595613 DOI: 10.1186/s12876-019-1030-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/20/2019] [Indexed: 12/28/2022] Open
Abstract
Background Accurate evaluation of anti-tubercular therapy (ATT) responses is crucial for both diagnosis and treatment of intestinal tuberculosis (ITB). Little is known about the role of cross-sectional imaging techniques in ITB follow-up assessment. We aimed to investigate the accuracy of cross-sectional imaging modalities, CT enterography (CTE) and gastrointestinal ultrasound (GIUS), in the evaluation of ATT responses in ITB patients. Methods Patients diagnosed with ITB and followed up by CTE and/or GIUS were retrospectively searched in the databases. Clinical, imaging, laboratory and endoscopic data were collected at baseline and the first follow-up visit. Responses were graded as good, partial and no response based on protocols described in the literature and by our institution. CTE evaluation was based on changes in the lesion area, mural thickness, enhancement patterns and lymph nodes, while GIUS evaluation was based on changes in bowel wall morphology and the Limberg score. Clinical evaluation was used as the gold-standard evaluation method, which was determined by a comprehensive impression of endoscopic changes along with symptomatic improvement and laboratory tests, with imaging results masked. Results Twenty patients with ITB were enrolled in our study. The first follow-up time was from 2 to 12 months (average 6 months). According to the gold standard evaluation, 11 patients were evaluated as having a good ATT response, while 9 had a partial response. A total of 18 patients were followed up by CTE, while 7 were followed up by GIUS, depending on medical and/or financial considerations. The accuracy of CTE and GIUS was 83% (15/18) and 85.7% (6/7), respectively. The sensitivity, specificity, PPV and NPV of CTE were 88.9, 77.8, 80 and 87.5%, respectively. Moreover, the sensitivity, specificity, PPV and NPV of GIUS were 100, 50, 83.3 and 100%, respectively. By combining the results of CTE and GIUS results, the overall accuracy was 90%, with sensitivity and specificity of 91.7 and 87.5%, respectively. Conclusion To our knowledge, this is the first study exploring the accuracy of the cross-sectional imaging modalities CTE/GIUS in the evaluation of ATT responses. Our results indicated their promising application prospect in clinical practice as a non-invasive and cost-effective approach. Electronic supplementary material The online version of this article (10.1186/s12876-019-1030-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Li Ma
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qingli Zhu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yue Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wenbo Li
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xuan Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Liu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jianchu Li
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuxin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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Abstract
Introduction Tuberculosis is a disease that has been affecting mankind since time immemorial and it still continues to be a global health concern. Objective of the study was to evaluate the burden, clinical profile, diagnosis and diagnostic difficulties and outcome of abdominal tuberculosis (AbT) in non human immunodeficiency virus (HIV) infected adults in the department of gastroenterology at a tertiary care hospital over a period of two years. Material & methods It was an observational study and the study period was from January 2016 till January 2018. The patients who were sero positive for HIV virus were excluded from the study. Results The number of patients hospitalized during the period of 2016-2018 with abdominal tuberculosis was 58. The burden of tuberculosis of indoor patients was 1.3 cases per every 100 patients admitted. Presenting complaint of most of these patients [61%] was abdominal pain. Constitutional symptoms like fever; weight loss and loss of appetite were present in only 40% of the patients. Ascites was the presenting sign in around 45% of the patients. Peritoneum was the most common site of involvement [27 out of 58]. Almost all of these patients [25 out of 27] presented with abdominal pain and abdominal distension. Intestine was the second most common site. Ileocaecal involvement was present in fourteen patients, while other areas of colon were involved in five patients. All the 58 patients were given anti tubercular therapy. There was complete resolution of tuberculosis in 91% of cases [53 out of 58 patients]. Six patients developed drug induced liver injury. Death occurred in two patients who had disseminated tuberculosis. Conclusion Although the burden of the disease remains the same, availability of newer investigations has aided in its early diagnosis and availability of good drugs has reduced the mortality and morbidity.
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12
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Mandavdhare HS, Singh H, Dutta U, Sharma V. A real-world experience with 6 months of antitubercular therapy in abdominal tuberculosis. JGH OPEN 2019; 3:201-205. [PMID: 31276036 PMCID: PMC6586575 DOI: 10.1002/jgh3.12136] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 12/02/2018] [Accepted: 12/04/2018] [Indexed: 12/21/2022]
Abstract
Background and Aim Abdominal tuberculosis is an important form of extrapulmonary tuberculosis. Evidence from clinical trials suggests that 6 months of antitubercular therapy (ATT) is sufficient for abdominal tuberculosis. Methods We report real-world experience with 6 months of ATT based on a retrospective analysis of patients with abdominal tuberculosis seen at a large tertiary care hospital in India. Results Of 101 patients, 93 with complete records were included. The mean age was 35.90 ± 14.06 years, and 53 were males (56.98%). A total of 42 patients (45.16%) had intestinal involvement, 24 (25.08%) had peritoneal, 22 (23.65%) had combined involvement, and 5 patients (5.37%) had isolated lymph nodal involvement. Six patients received prolonged ATT. Six patients developed ATT-induced hepatitis. Of 64 patients with intestinal involvement, 45 had stricturing disease (70.3%), of whom 7 (15.5%) required surgery due to refractory symptoms. Overall, there was one death, and eight patients (including one with massive gastrointestinal bleeding) needed surgery. Conclusion Six months of ATT is associated with objective clinical response in most of the patients of abdominal tuberculosis.
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Affiliation(s)
- Harshal S Mandavdhare
- Department of Gastroenterology and General Surgery Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Harjeet Singh
- Department of Gastroenterology and General Surgery Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Usha Dutta
- Department of Gastroenterology and General Surgery Postgraduate Institute of Medical Education and Research Chandigarh India
| | - Vishal Sharma
- Department of Gastroenterology and General Surgery Postgraduate Institute of Medical Education and Research Chandigarh India
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Use of steroids for abdominal tuberculosis: a systematic review and meta-analysis. Infection 2018; 47:387-394. [PMID: 30324229 DOI: 10.1007/s15010-018-1235-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/08/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The role of adjunctive steroids in abdominal tuberculosis is unclear. OBJECTIVE To evaluate effect of adjunctive use of steroids for abdominal tuberculosis in reducing/preventing complications. METHODS We searched electronic databases (Medline, Embase, CENTRAL, Scopus, Web of Science, CINAHL) from inception to 25th June 2018 using the terms "abdominal tuberculosis" OR "intestinal tuberculosis" OR "peritoneal tuberculosis" OR "tuberculous peritonitis" AND steroids OR methylprednisolone OR prednisolone. Bibliography of potential articles was also searched. We included studies comparing adjunctive steroids to antitubercular therapy (ATT) alone. We excluded non-English articles, case reports, reviews and unrelated papers. The primary outcome was a comprehensive clinical outcome including need for surgery or the presence of symptomatic stricture (abdominal pain or intestinal obstruction). Quality assessment of included studies was done using ROBINS-I tool. Random-effects model was used to calculate the summary effect for all the outcomes. RESULTS Of total 633 records, three studies on peritoneal tuberculosis were included in meta-analysis. These papers were of poor quality (one quasi-randomised study and two retrospective cohort studies). Meta-analyses showed adjunctive steroids, with ATT is more effective than ATT alone in tuberculous peritonitis patients for the prevention of composite end point (RR 0.15 [0.04, 0.62], p = 0.008), symptomatic stricture(RR 0.15 [0.04-0.62] p = 0.008) and intestinal obstruction (RR 0.18 [0.03-0.99] p = 0.05). CONCLUSION The data on use of steroids for abdominal tuberculosis are limited to peritoneal tuberculosis. Although steroids seem to have some benefit in patients of tubercular peritonitis, the poor quality of studies limits the generalisability of the findings. SYSTEMATIC REVIEW REGISTRATION NUMBER CRD42016047347.
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Singh H, Krishnamurthy G, Rajendran J, Sharma V, Mandavdhare H, Kumar H, Deen Yadav T, Vasishta RK, Singh R. Surgery for Abdominal Tuberculosis in the Present Era: Experience from a Tertiary-Care Center. Surg Infect (Larchmt) 2018; 19:640-645. [PMID: 30044168 DOI: 10.1089/sur.2018.077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The role of surgery in abdominal tuberculosis is being redefined, as many patients will be candidates for endoscopic dilatation rather than open surgery. METHODS A retrospective analysis was done of the surgical procedures performed in patients with abdominal tuberculosis in a large tertiary-care center in North India. Details such as clinical presentations, previous history of tuberculosis, any anti-tubercular therapy (ATT), Mantoux skin test results, and the surgical procedures and findings were recorded. Short-term outcomes also were analyzed. RESULTS Thirty-five patients (26 male) were included, and the median age at presentation was 24 years (range 12-80 years). Sixteen patients had received prior ATT for abdominal tuberculosis. The indication for surgery was intestinal obstruction, perforation, and bleeding in 23 (66%), 10 (29%), and 2 (6%) respectively. Twenty-eight patients had intestinal strictures, with the ileum being the most common site (n = 21). Perforation was present in 10 patients, of which six had multiple perforations. Cocoon abdomen was present in four patients, two of whom had associated small-bowel stricture. Among 33 patients who underwent bowel resection, 14 had ileo-cecal resection/right hemicolectomy. The rest had small-bowel resection. Primary anastomosis and stoma creation was performed in 12 (36%) and 21 (64%), respectively. Post-operative intra-abdominal collections (p = 0.02) and incision dehiscence (p = 0.05) were more common in patients having stoma creation. CONCLUSION Surgical intervention is warranted in a subset of patients with abdominal tuberculosis and may be required in patients with recurrent intestinal obstruction or pain, intestinal perforation, or gastrointestinal bleeding.
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Affiliation(s)
- Harjeet Singh
- 1 Department of General Surgery, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Gautham Krishnamurthy
- 1 Department of General Surgery, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Jayapal Rajendran
- 1 Department of General Surgery, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Vishal Sharma
- 2 Department of Gastroenterology, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Harshal Mandavdhare
- 2 Department of Gastroenterology, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Hemanth Kumar
- 1 Department of General Surgery, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Thakur Deen Yadav
- 1 Department of General Surgery, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Rakesh Kumar Vasishta
- 3 Department of Histopathology, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Rajinder Singh
- 1 Department of General Surgery, Post Graduate Institute of Medical Education and Research , Chandigarh, India
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