Validation of models using basic parameters to differentiate intestinal tuberculosis from Crohn’s disease: A multicenter study from Asia

Background Data on external validation of models developed to distinguish Crohn’s disease (CD) from intestinal tuberculosis (ITB) are limited. This study aimed to validate and compare models using clinical, endoscopic, and/or pathology findings to differentiate CD from ITB. Methods Data from newly diagnosed ITB and CD patients were retrospectively collected from 5 centers located in Thailand or Hong Kong. The data was applied to Lee, et al., Makharia, et al., Jung, et al., and Limsrivilai, et al. model. Results Five hundred and thirty patients (383 CD, 147 ITB) with clinical and endoscopic data were included. The area under the receiver operating characteristic curve (AUROC) of Limsrivilai’s clinical-endoscopy (CE) model was 0.853, which was comparable to the value of 0.862 in Jung’s model (p = 0.52). Both models performed significantly better than Lee’s endoscopy model (AUROC: 0.713, p<0.01). Pathology was available for review in 199 patients (116 CD, 83 ITB). When 3 modalities were combined, Limsrivilai’s clinical-endoscopy-pathology (CEP) model performed significantly better (AUROC: 0.887) than Limsrivilai’s CE model (AUROC: 0.824, p = 0.01), Jung’s model (AUROC: 0.798, p = 0.005) and Makharia’s model (AUROC: 0.637, p<0.01). In 83 ITB patients, the rate of misdiagnosis with CD when used the proposed cutoff values in each original study was 9.6% for Limsrivilai’s CEP, 15.7% for Jung’s, and 66.3% for Makharia’s model. Conclusions Scoring systems with more parameters and diagnostic modalities performed better; however, application to clinical practice is still limited owing to high rate of misdiagnosis of ITB as CD. Models integrating more modalities such as imaging and serological tests are needed.

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Recent advancements in management of gastrointestinal tuberculosis

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20183559 ◽

2018 ◽

Vol 5 (9) ◽

pp. 3730

Author(s):

Basim F. Khan ◽

Ahmed M. Basha ◽

Bandar R. Bakhurji ◽

Bader J. Aldossari ◽

Abdulaziz S. Alsumaihi ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Good Accuracy ◽

Clinical Presentation ◽

Intestinal Tuberculosis ◽

Scoring Systems ◽

Abdominal Tuberculosis ◽

Diagnostic Challenge ◽

Important Concern ◽

Diagnostic Modalities

Abdominal tuberculosis and its protean manifestations still create a worldwide diagnostic challenge for clinicians and remain an important concern in the developing world. Crohn’s disease, which is being increasingly recognized in countries where intestinal tuberculosis is prevalent, needs to be differentiated as the two diseases resemble each other in their clinical presentation, and in their radiological, endoscopic, and histological findings. New diagnostic modalities and scoring systems have facilitated the differentiation of Crohn’s disease from intestinal tuberculosis with good accuracy. Randomized trials have shown 6 months of therapy to be equivalent to longer durations of treatment for patients with abdominal tuberculosis.

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Su1921 – Validation of Scoring Systems for Differentiating Intestinal Tuberculosis from Crohn’s Disease Utilizing Clinical, Endoscopic, and Pathological Findings

Gastroenterology ◽

10.1016/s0016-5085(19)38558-0 ◽

2019 ◽

Vol 156 (6) ◽

pp. S-661

Author(s):

Asawin Sudcharoen ◽

Ananya Pongpaibul ◽

Nonthalee Pausawasdi ◽

Phunchai Charatcharoenwitthaya ◽

Julajak Limsrivilai

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Intestinal Tuberculosis ◽

Scoring Systems ◽

Pathological Findings

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P060 THE TREND OF DIAGNOSTIC COMPETENCY OF CROHN’S DISEASE IN THAI POPULATION FOR THE PAST TWO DECADES

Inflammatory Bowel Diseases ◽

10.1093/ibd/zaa010.035 ◽

2020 ◽

Vol 26 (Supplement_1) ◽

pp. S15-S15

Author(s):

Natapat Chaisidhivej ◽

Satimai Aniwan ◽

Nonthalee Pausawasdi ◽

Julajak Limsrivilai

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Intestinal Tuberculosis ◽

Scoring Systems ◽

Diagnosis Delay ◽

Thai Population ◽

Delay In Diagnosis ◽

Presenting Symptoms ◽

The Past ◽

Uncommon Disease

Abstract Background Crohn’s disease (CD) is an uncommon disease in Thai population, leading to delay in diagnosis due to lacking of familiarity, which may increase disease complications. One of the most problematic issues is to differentiate CD from intestinal tuberculosis (ITB), and many scoring systems have been introduced since 2006. However, competency of diagnosis of CD in the latter period is still unknown in Thailand. Our aim is to compare this competency in the period of 2000–2006, 2007–2012, and 2013–2018. Methods Retrospective study collecting all patients, whom diagnosed with CD in two tertiary referral centers in Bangkok, was performed. We focused the competency of diagnosis of each period by using the following variables; duration of presenting symptoms, number of colonoscopy before diagnosis, receiving anti-TB medication before diagnosis, and having first surgery before and at diagnosis. Comparison in each parameter was done by statistical analysis. Results A total of 190 CD patients were identified. Characteristics of patients were shown in Table 1. The patients were classified into 3 groups by using time period of diagnosis, which included 27, 62, and 101 patients in the 2000–2006, 2007–2012, and 2013–2018 period groups, respectively. Mean age was 38.6, 46, and 47.7 respectively. Nearly 50% were male, and 80% had inflammatory phenotypes in all groups. The median duration of presenting symptoms was 15.8, 10.1, and 11.7 months in the 2000–2006, 2007–2012, and 2013–2018 period groups, respectively (p=0.67). The percentage of patients receiving anti-TB medication before diagnosis was 19.2%, 9.8%, and 10.2%, in each group respectively (p=0.31). The number of colonoscopy for 1, 2, and >2 times before diagnosis were 56.5%, 30.4%, and 13.1%; 55.7%, 24.6%, and 19.7%; and 41.7%, 38.5%, and 19.8% in each group, respectively (p=0.32). The percentage of patients undergoing first surgery before or at diagnosis were 33.3%, 21.0%, and 26.8%, respectively (p=0.80). Conclusion Competency in diagnosis of CD in Thailand has not changed in the past 2 decades. It is necessary to find effective methods helping physicians differentiate CD from other conditions to avoid the diagnosis delay, which may improve treatment outcomes.

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