Differentiation of Crohn’s disease from intestinal Tuberculosis and Ulcerative Colitis: a single tertiary centre experience in Nepal

Abstract

Introduction: Differentiating intestinal luminal tuberculosis from Crohn’s disease (CD) is an important clinical challenge of considerable therapeutic significance. Likewise differentiating ulcerative colitis from Crohn’s disease with colonic or ileocolonic involvement is difficult. The aim of this study was to investigate the clinical, endoscopic, radiologic and histological features that will help to differentiate Crohn’s disease from intestinal luminal tuberculosis as well as from ulcerative colitis.

Methods: A total of 40 patients diagnosed with Crohn’s disease, Intestinal luminal TB and Ulcerative colitis who were admitted under the Gastroenterology Department TUTH from July 2017 to February 2018 were included in this retrospective study. Clinical, endoscopic, radiologic, histopathologic and microbiologic features as well as response to treatment of these patients were studied in detail.

Results: Among 40 patients, Intestinal TB was diagnosed in 52.5% patients, ulcerative colitis in 32.5% patients and Crohn’s disease in 15% patients. There was a higher incidence of fever, night sweats, lung involvement and ascites in Intestinal TB whereas diarrhea, perianal disease, hematochezia and extraintestinal were predictive for Crohn’s disease. Similarly on colonoscopy involvement of IC valve, patulous IC valve and transverse ulcers favored a diagnosis of intestinal TB in contrast to Crohn’s disease where longitudinal ulcers, aphthous ulcers, cobblestone appearance and rectal involvement were seen. Similarly the diagnosis of Ulcerative colitis was favored by rectal involvement and contiguous involvement whereas patients with Crohn’s disease had significantly more deep ulcers, cobblestoning, skip areas and ileal involvement.

Conclusions: Crohn’s disease must be differentiated from Intestinal luminal TB and Ulcerative colitis before treatment. According to our study, a combination of clinical, endoscopic, serologic, radiologic, histopathologic and microbiologic features can be utilized in order to reliably predict and distinguish Crohn’s disease from Intestinal luminal TB and from Ulcerative colitis. In complicated cases deep enteroscopy and surgery may be needed before a confident diagnosis is reached.