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CC BY-NC-ND 4.0 · Journal of Gastrointestinal Infections 2022; 12(01): 057-060
DOI: 10.1055/s-0042-1757402
Evidence-Based Commentary

Evidence-Based Commentary: Ascitic Adenosine Deaminase in the Diagnosis of Peritoneal Tuberculosis

Amol Sonyabapu Dahale
1   Department of Medical Gastroenterology, Dr. D. Y. Patil Medical College, Dr. D. Y. Patil University, Pune, Maharashtra, India
,
Ashok Dalal 
2   Department of Medical Gastroenterology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
› Author Affiliations Funding None.
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How is Peritoneal Tuberculosis Suspected and Diagnosed?

Peritoneal tuberculosis (TBP) forms a significant proportion of abdominal tuberculosis (TB). Incidence of TBP in literature varies from 39 to 77% of total abdominal TB cases.[1] The myriad clinical presentations, paucibacillary nature of abdominal TB, and fastidious nature of tubercular bacteria make it very difficult to suspect TBP and near impossible to prove by routine microbial analysis. Peritoneoscopy with peritoneal biopsies for histopathology and bacteriological studies may be required if noninvasive methods are unable to clinch the diagnosis.[2] [3] Peritoneoscopy is invasive with a 3% adverse events rate associated with it.[3] Additionally, most of these patients are surgically unfit and de facto high risk like having underlying cirrhosis. Given the higher incidence and limited resources in highly prevalent TB areas, highly sophisticated and invasive investigations may not be within reach of the majority of the population. Adenosine deaminase (ADA) in peritoneal fluid offers a feasible, sensitive, and highly specific test for TBP. Given the varied incidence of TB in developed and developing nations, the utility of ascitic ADA is likely to be more in high TB endemic regions. To add to the confusion, multiple testing methods and different cutoffs have been reported. Evaluation of the ascitic fluid including culture and measurement of ADA are the first line strategy for diagnosis of tuberculous peritonitis.

Ethical Statement

Not applicable.


Author Contributions

Amol Dahale: Initial draft and approval. Ashok Dalal:- Initial draft, revision and approval.


Data Availability Statement

There is no data associated with this work.




Publication History

Received: 16 April 2022

Accepted: 25 May 2022

Article published online:
22 September 2023

© 2022. Gastroinstestinal Infection Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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