07 August 2019 (online)
Though the primary site of tuberculosis is lung, it can virtually affect any organ of the body. The gastrointestinal tract is the sixth most frequent site of extrapulmonary involvement. Apart from the gut, the peritoneum, abdominal lymph nodes, and more rarely, the solid organs liver, pancreas, and spleen may be infected with tuberculosis. The most common site of involvement of the gastrointestinal tuberculosis is the ileocecal region followed by ascending colon, jejunum, appendix, duodenum, stomach, esophagus, sigmoid colon, and rectum.
In the study “clinical, imaging, and endoscopic profile of patients with abdominal tuberculosis” by Shafiq et al, the author has reported a single center experience of 76 cases of abdominal tuberculosis over the study period of 3 years. This is consistent with the statistics that India has the world's largest number of tuberculosis cases which is around 26% of the world TB cases, followed by China and South Africa. Most of the findings in this study are consistent with the earlier reports but for slight male preponderance.
The incidence of TB in developed countries too is on the rise due to the increasing prevalence of immunocompromised individuals mainly due to the pandemic of acquired immunodeficiency syndrome (AIDS) and changed demography with growing immigrant's population. The burden of extrapulmonary tuberculosis is estimated to range from 15 to 20% of all TB cases in HIV-negative patients, while in HIV-positive subjects, it accounts for 40 to 50% of new TB cases.
Extrapulmonary TB is not so commonly seen as pulmonary TB and often eludes early diagnosis until it is late. The late diagnosis is due to its nonspecific clinical presentation. The symptoms of vague pain in abdomen, diarrhea, and occasional fever are too nonspecific to suggest the diagnosis unless the treating physician has a high degree of suspicion. Most often such diagnosis comes to mind when the patient presents either with features of malabsorption or complications of obstruction in the presence of stricture causing narrowing of the lumen of ileum.
The patient symptoms of TB of the gastrointestinal (GI) tract vary depending on the organ involved. A patient may rarely present with dysphagia, odynophagia, and a mid-esophageal ulcer due to esophageal tuberculosis, dyspepsia and gastric outlet obstruction due to gastroduodenal tuberculosis, lower abdominal pain and hematochezia due to colonic tuberculosis, and annular rectal stricture and multiple perianal fistulae due to rectal and anal involvement.
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