Clinical, Colonoscopic, and Histological Profile of Colonic Tuberculosis in a Tertiary Hospital

 

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Background and Study Aims: Colonic tuberculosis is not uncommon in developing countries. As emigration to the West increases, it is worthwhile to recall the clinical, colonoscopic, and histopathological features of this condition.
Patients and Methods: The clinical, colonoscopic and histopathological findings were evaluated in 43 patients with colonic tuberculosis.
Results: Abdominal pain, weight loss, diarrhea, fever, and a lump in the abdomen were the commonest symptoms. Extraintestinal tuberculosis was present in 11 patients (26 %). Colonoscopy revealed ulcers in 30 patients (70 %), nodules in 24 (56 %), a deformed cecum and ileocecal valve in 17 (40 %), strictures in 10 (23 %), polypoid lesions in six (14 %), and fibrous bands forming mucosal bridges in three (7 %). The cecum and ascending colon were the commonest sites involved. Segmental tuberculosis was seen in six of the 32 patients (19 %) in whom full-length colonoscopy could be performed. Two or more sites were involved in 19 patients (44 %). Histopathology revealed well-formed granulomas in 23 patients (54 %). Fourteen of the above patients (61 %) had caseation and 11 (48 %) had confluence of the granulomas. Acid-fast bacilli were present in the biopsies from two patients (5 %). Ill-formed granulomas were seen in seven patients (16 %) and chronic inflammatory changes in 13 (30 %). Despite the various histopathological findings, all of the patients responded to antitubercular treatment and continued to remain asymptomatic during the follow-up period.
Conclusions: Colonoscopy with biopsy is a useful method for diagnosing colonic tuberculosis. Even in the absence of the classic histopathological features, a therapeutic trial may be indicated in a given clinical and colonoscopic setting. Follow-up is essential.

References

• 1 Bhansali S K. The challenge of abdominal tuberculosis in 310 cases.  Indian J Surg. 1978;  40 65-77
  PubMedGoogle Scholar
• 2 Tabrisky J, Lindstrom R R, Peters R, Lachman R S. Tuberculous enteritis: review of a protean disease.  Am J Gastroenterol. 1975;  63 49-57
  PubMedGoogle Scholar
• 3 Singh V, Kumar P, Kamal J. et al . Clinicocolonoscopic profile of colonic tuberculosis.  Am J Gastroenterol. 1996;  91 565-568
  PubMedGoogle Scholar
• 4 Bhargava D K, Tandon H D, Chawla T C. et al . Diagnosis of ileocecal and colonic tuberculosis by colonoscopy.  Gastrointest Endosc. 1985;  31 68-70
  CrossrefPubMedGoogle Scholar
• 5 Shah S, Thomas V, Mathan M. et al . Colonoscopic study of 50 patients with colonic tuberculosis.  Gut. 1992;  33 347-351
  CrossrefPubMedGoogle Scholar
• 6 Aoki G, Nagasako K, Nakae Y. et al . The fibercolonoscopic diagnosis of intestinal tuberculosis.  Endoscopy. 1975;  7 113-121
  PubMedGoogle Scholar
• 7 Bhargava D K, Kushwaha A KS, Dasarathy S. et al . Endoscopic diagnosis of segmental colonic tuberculosis.  Gastrointest Endosc. 1992;  38 571-574
  PubMedGoogle Scholar
• 8 Kalvaria I, Kottler R E, Marks I N. The role of colonoscopy in the diagnosis of tuberculosis.  J Clin Gastroenterol. 1988;  10 516-523
  PubMedGoogle Scholar
• 9 Pettengell K E, Pirie D, Simjee A E. Colonoscopic features of early intestinal tuberculosis (report of 11 cases ).  S Afr Med J. 1991;  79 279-280
  PubMedGoogle Scholar
• 10 Ferentzi C V, Sieck J O, Ali M A. Colonoscopic diagnosis and medical treatment of ten patients with colonic tuberculosis.  Endoscopy. 1988;  20 62-65
  PubMedGoogle Scholar
• 11 Radhakrishnan S, Nakib B, Shaikh H, Menon N K. The value of colonoscopy in schistosomal, tuberculous and amebic colitis: two year experience.  Dis Colon Rectum. 1986;  29 891-895
  PubMedGoogle Scholar
• 12 Misra S P, Misra V, Dwivedi M, Gupta S C. Colonic tuberculosis: clinical features, endoscopic appearance and management.  J Gastroenterol Hepatol. 1999;  14 723-729
  CrossrefPubMedGoogle Scholar
• 13 Das P, Shukla H S. Clinical diagnosis of abdominal tuberculosis.  Br J Surg. 1976;  63 941-946
  PubMedGoogle Scholar
• 14 Singh V, Jain A K, Agrawal A K. et al . Clinicopathological profile of abdominal tuberculosis.  Br J Clin Pract. 1995;  49 22-24
  PubMedGoogle Scholar
• 15 Naga M I, Okasha H H, Ismail Z. et al . Endoscopic diagnosis of colonic tuberculosis.  Gastrointest Endosc. 2001;  53 789-793
  CrossrefPubMedGoogle Scholar
• 16 Dye C, Scheele S, Dolin P. et al . Global burden of tuberculosis: estimated incidence, prevalence and mortality by country.  JAMA. 1999;  282 677-686
  CrossrefPubMedGoogle Scholar
• 17 Horvath K D, Whelan R L. Intestinal tuberculosis: return of an old disease.  Am J Gastroenterol. 1998;  93 692-696
  PubMedGoogle Scholar
• 18 Kim K M, Lee A, Choi K Y. et al . Intestinal tuberculosis: clinicopathologic analysis and diagnosis by endoscopic biopsy.  Am J Gastroenterol. 1998;  93 606-609
  CrossrefPubMedGoogle Scholar
• 19 Tarumi K, Koga H, Lida M. et al . Colonic aphthoid erosions as the only manifestation of tuberculosis: case report.  Gastrointest Endosc. 2002;  55 743-745
  CrossrefPubMedGoogle Scholar
• 20 Pulimood A B, Ramakrishna B S, Kurian G. et al . Endoscopic mucosal biopsies are useful in distinguishing granulomatous colitis due to Crohn’s disease from tuberculosis.  Gut. 1999;  45 537-541
  CrossrefPubMedGoogle Scholar
• 21 Sakai Y. Colonoscopic diagnosis of the intestinal tuberculosis.  Mater Med Pol. 1979;  11 275-278
  PubMedGoogle Scholar
• 22 Gan H T, Chen Y Q, Ouyang Q. et al . Differentiation between intestinal tuberculosis and Crohn’s disease in endoscopic biopsy specimens by polymerase chain reaction.  Am J Gastroenterol. 2002;  97 1446-1451
  CrossrefPubMedGoogle Scholar
• 23 Anand B S, Schneider F E, El-Zaatari F A. et al . Diagnosis of intestinal tuberculosis by polymerase chain reaction on endoscopic biopsy specimens.  Am J Gastroenterol. 1994;  89 2248-2249
  PubMedGoogle Scholar
• 24 Ha H K, Kim J K. The gastrointestinal tract. In: Haaga JR, Lanzieri CF, Gilkeson RC (eds) CT and MR imaging of the whole body, vol. 2. St. Louis; Mosby 2003: 1154-1169
  Google Scholar
• 25 Kashima K, Oka S, Tabata A. et al . Detection of anti-cord factor antibodies in intestinal tuberculosis for its differential diagnosis from Crohn’s disease and ulcerative colitis.  Dig Dis Sci. 1995;  40 2630-2634
  PubMedGoogle Scholar
• 26 Patel N, Amarapurkar D N, Kulshreshta P P. et al . Utility of serological markers in inflammatory bowel disease.  Indian J Gastroenterol. 2002;  21 A37
  PubMedGoogle Scholar
• 27 Thomas G AO, Swift G L, Green J T. et al . Controlled trial of antituberculous chemotherapy in Crohn’s disease: a five year follow up study.  Gut. 1998;  42 497-500
  PubMedGoogle Scholar

J. F. Alvares, M. D., D. M., D. N. B.

c/o Adv C. F. Alvares · Near the Holy Spirit Church · Margao-Goa · India ·

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Email: filipealvares@yahoo.co.in