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Tuberculous enteritis

Authors
Louis-Michel Wong Kee Song, MD, FRCP(C)
Norman E Marcon, MD, FRCP(C)
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Elinor L Baron, MD, DTMH

INTRODUCTION

Extrapulmonary tuberculosis (TB) affects approximately 20 percent of TB cases in immunocompetent individuals and 50 percent of cases in HIV-infected patients. Tuberculous enteritis is a form of extrapulmonary TB that can involve any aspect of the gastrointestinal tract. It accounts for 1 to 3 percent of TB worldwide [1] and represents the sixth most frequent form of extrapulmonary TB (after lymphatic, genitourinary, bone and joint, miliary, and meningeal tuberculosis) [2]. The epidemiology of tuberculous enteritis varies widely around the globe, influenced in part by age, sex, socioeconomic factors, immune status, and Mycobacterium tuberculosis genotype [3]. Young adults, primarily women, are mostly affected in regions like Pakistan, Turkey, and West Africa, whereas a lower disease incidence but similar or greater numbers of male patients are reported in studies from China, Singapore, India, and the United Kingdom [3].

Prior to antituberculous therapy, gastrointestinal involvement was observed in 55 to 90 percent of patients with active pulmonary TB but since has been observed in approximately 25 percent of cases [4].

Issues related to gastrointestinal TB will be reviewed here; issues related to other aspects of extrapulmonary TB are discussed separately. (See "Clinical manifestations, diagnosis, and treatment of extrapulmonary and miliary tuberculosis".)

PATHOGENESIS

The pathogenesis of tuberculous enteritis has been attributed to four mechanisms [5-7]:

Swallowing infected sputum

            

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Literature review current through: Nov 2016. | This topic last updated: Fri Jun 17 00:00:00 GMT+00:00 2016.
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References
Top
  1. Farer LS, Lowell AM, Meador MP. Extrapulmonary tuberculosis in the United States. Am J Epidemiol 1979; 109:205.
  2. Dasgupta A, Singh N, Bhatia A. Abdominal tuberculosis: a histopathological study with special reference to intestinal perforation and mesenteric vasculopathy. J Lab Physicians 2009; 1:56.
  3. Donoghue HD, Holton J. Intestinal tuberculosis. Curr Opin Infect Dis 2009; 22:490.
  4. Haddad FS, Ghossain A, Sawaya E, Nelson AR. Abdominal tuberculosis. Dis Colon Rectum 1987; 30:724.
  5. Marshall JB. Tuberculosis of the gastrointestinal tract and peritoneum. Am J Gastroenterol 1993; 88:989.
  6. Horvath KD, Whelan RL. Intestinal tuberculosis: return of an old disease. Am J Gastroenterol 1998; 93:692.
  7. Kapoor VK. Abdominal tuberculosis. Postgrad Med J 1998; 74:459.
  8. Petrosyan M, Mason RJ. Tuberculous enteritis presenting as small-bowel obstruction. Clin Gastroenterol Hepatol 2006; 4:xxiii.
  9. García-Díaz RA, Ruiz-Gómez JL, Rodríguez-Sanjuan JC, et al. Perforation of the colon caused by intestinal tuberculosis. Dis Colon Rectum 2006; 49:927; author reply 927.
  10. Ha HK, Ko GY, Yu ES, et al. Intestinal tuberculosis with abdominal complications: radiologic and pathologic features. Abdom Imaging 1999; 24:32.
  11. Balthazar EJ, Gordon R, Hulnick D. Ileocecal tuberculosis: CT and radiologic evaluation. AJR Am J Roentgenol 1990; 154:499.
  12. Suri S, Gupta S, Suri R. Computed tomography in abdominal tuberculosis. Br J Radiol 1999; 72:92.
  13. Almadi MA, Ghosh S, Aljebreen AM. Differentiating intestinal tuberculosis from Crohn's disease: a diagnostic challenge. Am J Gastroenterol 2009; 104:1003.
  14. Bhargava DK, Kushwaha AK, Dasarathy S, et al. Endoscopic diagnosis of segmental colonic tuberculosis. Gastrointest Endosc 1992; 38:571.
  15. Shah S, Thomas V, Mathan M, et al. Colonoscopic study of 50 patients with colonic tuberculosis. Gut 1992; 33:347.
  16. Misra SP, Misra V, Dwivedi M, Gupta SC. Colonic tuberculosis: clinical features, endoscopic appearance and management. J Gastroenterol Hepatol 1999; 14:723.
  17. Aston NO. Abdominal tuberculosis. World J Surg 1997; 21:492.
  18. Kalvaria I, Kottler RE, Marks IN. The role of colonoscopy in the diagnosis of tuberculosis. J Clin Gastroenterol 1988; 10:516.
  19. Singh V, Kumar P, Kamal J, et al. Clinicocolonoscopic profile of colonic tuberculosis. Am J Gastroenterol 1996; 91:565.
  20. Kim KM, Lee A, Choi KY, et al. Intestinal tuberculosis: clinicopathologic analysis and diagnosis by endoscopic biopsy. Am J Gastroenterol 1998; 93:606.
  21. Anand BS, Schneider FE, El-Zaatari FA, et al. Diagnosis of intestinal tuberculosis by polymerase chain reaction on endoscopic biopsy specimens. Am J Gastroenterol 1994; 89:2248.
  22. Kochhar R, Rajwanshi A, Goenka MK, et al. Colonoscopic fine needle aspiration cytology in the diagnosis of ileocecal tuberculosis. Am J Gastroenterol 1991; 86:102.
  23. Alvares JF, Devarbhavi H, Makhija P, et al. Clinical, colonoscopic, and histological profile of colonic tuberculosis in a tertiary hospital. Endoscopy 2005; 37:351.
  24. Kirsch R, Pentecost M, Hall Pde M, et al. Role of colonoscopic biopsy in distinguishing between Crohn's disease and intestinal tuberculosis. J Clin Pathol 2006; 59:840.
  25. Pulimood AB, Ramakrishna BS, Kurian G, et al. Endoscopic mucosal biopsies are useful in distinguishing granulomatous colitis due to Crohn's disease from tuberculosis. Gut 1999; 45:537.
  26. Pulimood AB, Peter S, Ramakrishna B, et al. Segmental colonoscopic biopsies in the differentiation of ileocolic tuberculosis from Crohn's disease. J Gastroenterol Hepatol 2005; 20:688.
  27. Dilauro S, Crum-Cianflone NF. Ileitis: when it is not Crohn's disease. Curr Gastroenterol Rep 2010; 12:249.
  28. Lee YJ, Yang SK, Byeon JS, et al. Analysis of colonoscopic findings in the differential diagnosis between intestinal tuberculosis and Crohn's disease. Endoscopy 2006; 38:592.
  29. Makharia GK, Srivastava S, Das P, et al. Clinical, endoscopic, and histological differentiations between Crohn's disease and intestinal tuberculosis. Am J Gastroenterol 2010; 105:642.
  30. Gabellec MM, Panzanelli P, Sassoè-Pognetto M, Lledo PM. Synapse-specific localization of vesicular glutamate transporters in the rat olfactory bulb. Eur J Neurosci 2007; 25:1373.
  31. Li X, Liu X, Zou Y, et al. Predictors of clinical and endoscopic findings in differentiating Crohn's disease from intestinal tuberculosis. Dig Dis Sci 2011; 56:188.
  32. Pulimood AB, Amarapurkar DN, Ghoshal U, et al. Differentiation of Crohn's disease from intestinal tuberculosis in India in 2010. World J Gastroenterol 2011; 17:433.
  33. Yu H, Liu Y, Wang Y, et al. Clinical, endoscopic and histological differentiations between Crohn's disease and intestinal tuberculosis. Digestion 2012; 85:202.
  34. Wagner TE, Huseby ES, Huseby JS. Exacerbation of Mycobacterium tuberculosis enteritis masquerading as Crohn's disease after treatment with a tumor necrosis factor-alpha inhibitor. Am J Med 2002; 112:67.
  35. Tony J, Sunilkumar K, Thomas V. Randomized controlled trial of DOTS versus conventional regime for treatment of ileocecal and colonic tuberculosis. Indian J Gastroenterol 2008; 27:19.
  36. Park YS, Jun DW, Kim SH, et al. Colonoscopy evaluation after short-term anti-tuberculosis treatment in nonspecific ulcers on the ileocecal area. World J Gastroenterol 2008; 14:5051.
  37. Giouleme O, Paschos P, Katsaros M, et al. Intestinal tuberculosis: a diagnostic challenge--case report and review of the literature. Eur J Gastroenterol Hepatol 2011; 23:1074.
  38. Makharia GK, Ghoshal UC, Ramakrishna BS, et al. Intermittent Directly Observed Therapy for Abdominal Tuberculosis: A Multicenter Randomized Controlled Trial Comparing 6 Months Versus 9 Months of Therapy. Clin Infect Dis 2015; 61:750.
  39. Bhasin DK, Sharma BC, Dhavan S, et al. Endoscopic balloon dilation of ileal stricture due to tuberculosis. Endoscopy 1998; 30:S44.