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CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2017; 08(01): 01-11
DOI: 10.4103/jde.jde_48_16
Review Article
Journal of Digestive Endoscopy

Endoscopic features of gastrointestinal tuberculosis and crohn’s disease

Praneeth Moka
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
,
Vineet Ahuja
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
,
Govind K. Makharia
Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations
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Publication History

Publication Date:
25 September 2019 (online)

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Abstract

Endoscopic examination of the gastrointestinal (GI) tract plays a very important role in the diagnosis and follow-up of patients with Crohn’s disease (CD) and intestinal tuberculosis (TB). The clinical, morphological, and histological features of GI TB and CD are so similar that it becomes difficult to differentiate between these two entities. In geographical regions such as India where both GI TB and CD are prevalent, differential diagnosis between the two is challenging. While there is a lot of similarities between these two disorders, these two can be differentiated from each other with a combination of clinical, endoscopic, histological, radiological, and endoscopic features. The observation of the characteristic lesions at endoscopic examination and the extent of involvement in CD and intestinal TB is an important step in differentiation between these two disorders. While the most important endoscopic characteristics such as involvement of left side of the colon and presence of longitudinal ulcerations and cobblestoning support a diagnosis of CD, predominant involvement of ileocecal region and transverse ulcers support the diagnosis of intestinal TB. In this review, we have described the usefulness and limitations of endoscopic modalities in the diagnosis and differentiation of intestinal TB and CD.

Key words

Cobblestoning - Crohn’s disease - gastrointestinal tuberculosis
 

  • References

  • 1 Sharma SK, Mohan A. Extrapulmonary tuberculosis. Indian J Med Res 2004; 120: 316-53
    PubMedGoogle Scholar
  • 2 Golden MP, Vikram HR. Extrapulmonary tuberculosis: An overview. Am Fam Physician 2005; 72: 1761-8
    PubMedGoogle Scholar
  • 3 Rieder HL, Snider Jr DE, Cauthen GM. Extrapulmonary tuberculosis in the United States. Am Rev Respir Dis 1990; 141: 347-51
    CrossrefPubMedGoogle Scholar
  • 4 Lazarus AA, Thilagar B. Abdominal tuberculosis. Dis Mon 2007; 53: 32-8
    CrossrefPubMedGoogle Scholar
  • 5 Kapoor VK, Sharma LK. Abdominal tuberculosis. Br J Surg 1988; 75: 2-3
    CrossrefPubMedGoogle Scholar
  • 6 Bhansali SK. Abdominal tuberculosis. Experiences with 300 cases. Am J Gastroenterol 1977; 67: 324-37
    PubMedGoogle Scholar
  • 7 Bhansali SK. Gastrointestinal perforations. A clinical study of 96 cases. J Postgrad Med 1967; 13: 1-12
    PubMedGoogle Scholar
  • 8 Amarapurkar DN, Patel ND, Rane PS. Diagnosis of Crohn's disease in India where tuberculosis is widely prevalent. World J Gastroenterol 2008; 14: 741-6
    CrossrefPubMedGoogle Scholar
  • 9 Das K, Ghoshal UC, Dhali GK, Benjamin J, Ahuja V, Makharia GK. Crohn's disease in India: A multicenter study from a country where tuberculosis is endemic. Dig Dis Sci 2009; 54: 1099-107
    CrossrefPubMedGoogle Scholar
  • 10 Makharia GK, Ramakrishna BS, Abraham P, Choudhuri G, Misra SP, Ahuja V. et al Survey of inflammatory bowel diseases in India. Indian J Gastroenterol 2012; 31: 299-306
    CrossrefPubMedGoogle Scholar
  • 11 Epstein D, Watermeyer G, Kirsch R. Review article: The diagnosis and management of Crohn's disease in populations with high-risk rates for tuberculosis. Aliment Pharmacol Ther 2007; 25: 1373-88
    CrossrefPubMedGoogle Scholar
  • 12 Ouyang Q, Tandon R, Goh KL, Ooi CJ, Ogata H, Fiocchi C. The emergence of inflammatory bowel disease in the Asian Pacific region. Curr Opin Gastroenterol 2005; 21: 408-13
    PubMedGoogle Scholar
  • 13 Jayanthi V, Robinson RJ, Malathi S, Rani B, Balambal R, Chari S. et al Does Crohn's disease need differentiation from tuberculosis?. J Gastroenterol Hepatol 1996; 11: 183-6
    CrossrefPubMedGoogle Scholar
  • 14 Arnold C, Moradpour D, Blum HE. Tuberculous colitis mimicking Crohn's disease. Am J Gastroenterol 1998; 93: 2294-6
    CrossrefPubMedGoogle Scholar
  • 15 Kim ES, Song GA, Cho KB, Park KS, Kim KO, Jang BI. et al Significant risk and associated factors of active tuberculosis infection in Korean patients with inflammatory bowel disease using anti-TNF agents. World J Gastroenterol 2015; 21: 3308-16
    CrossrefPubMedGoogle Scholar
  • 16 Byun JM, Lee CK, Rhee SY, Kim HJ, Kim JW, Shim JJ. et al The risk of tuberculosis in Korean patients with inflammatory bowel disease receiving tumor necrosis factor-α blockers. J Korean Med Sci 2015; 30: 173-9
    CrossrefPubMedGoogle Scholar
  • 17 Andersen NN, Jess T. Risk of infections associated with biological treatment in inflammatory bowel disease. World J Gastroenterol 2014; 20: 16014-9
    CrossrefPubMedGoogle Scholar
  • 18 Sood A, Midha V. Epidemiology of inflammatory bowel disease in Asia. Indian J Gastroenterol 2007; 26: 285-9
    PubMedGoogle Scholar
  • 19 Pulimood AB, Amarapurkar DN, Ghoshal U, Phillip M, Pai CG, Reddy DN. et al Differentiation of Crohn's disease from intestinal tuberculosis in India in 2010. World J Gastroenterol 2011; 17: 433-43
    CrossrefPubMedGoogle Scholar
  • 20 Ramakrishna BS, Makharia GK, Ahuja V, Ghoshal UC, Jayanthi V, Perakath B. et al Indian Society of Gastroenterology consensus statements on Crohn's disease in India. Indian J Gastroenterol 2015; 34: 3-22
    CrossrefPubMedGoogle Scholar
  • 21 Ooi CJ, Makharia GK, Hilmi I, Gibson PR, Fock KM, Ahuja V. et al Asia-Pacific consensus statements on Crohn's disease. Part 2: Management. J Gastroenterol Hepatol 2016; 31: 56-68
    CrossrefPubMedGoogle Scholar
  • 22 Kapoor VK. Abdominal tuberculosis: The Indian contribution. Indian J Gastroenterol 1998; 17: 141-7
    PubMedGoogle Scholar
  • 23 Makharia GK, Srivastava S, Das P, Goswami P, Singh U, Tripathi M. et al Clinical, endoscopic, and histological differentiations between Crohn's disease and intestinal tuberculosis. Am J Gastroenterol 2010; 105: 642-51
    CrossrefPubMedGoogle Scholar
  • 24 Li X, Liu X, Zou Y, Ouyang C, Wu X, Zhou M. et al Predictors of clinical and endoscopic findings in differentiating Crohn's disease from intestinal tuberculosis. Dig Dis Sci 2011; 56: 188-96
    CrossrefPubMedGoogle Scholar
  • 25 Leder RA, Low VH. Tuberculosis of the abdomen. Radiol Clin North Am 1995; 33: 691-705
    CrossrefPubMedGoogle Scholar
  • 26 Jarman BT. Small bowel imaging. Surg Clin North Am 2011; 91: 109-25
    CrossrefPubMedGoogle Scholar
  • 27 Morel P, Alexander-Williams J, Rohner A. Relation between flow-pressure-diameter studies in experimental stenosis of rabbit and human small bowel. Gut 1990; 31: 875-8
    CrossrefPubMedGoogle Scholar
  • 28 Anand BS, Nanda R, Sachdev GK. Response of tuberculous stricture to antituberculous treatment. Gut 1988; 29: 62-9
    CrossrefPubMedGoogle Scholar
  • 29 Rieder F, Latella G, Magro F, Yuksel ES, Higgins PD, Di Sabatino A. et al European Crohn's and colitis organisation topical review on prediction, diagnosis and management of fibrostenosing Crohn's disease. J Crohns Colitis 2016; 10: 873-85
    CrossrefPubMedGoogle Scholar
  • 30 Sharma MP, Bhatia V. Abdominal tuberculosis. Indian J Med Res 2004; 120: 305-15
    PubMedGoogle Scholar
  • 31 Haddad FS, Ghossain A, Sawaya E, Nelson AR. Abdominal tuberculosis. Dis Colon Rectum 1987; 30: 724-35
    CrossrefPubMedGoogle Scholar
  • 32 Chen WS, Su WJ, Wang HS, Jiang JK, Lin JK, Lin TC. Large bowel tuberculosis and possible influencing factors for surgical prognosis: 30 years' experience. World J Surg 1997; 21: 500-4
    CrossrefPubMedGoogle Scholar
  • 33 Misra SP, Dwivedi M, Misra V, Gupta M, Kunwar BK. Endoscopic biopsies from normal-appearing terminal ileum and cecum in patients with suspected colonic tuberculosis. Endoscopy 2004; 36: 612-6
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Leung VK, Tang WL, Cheung CH, Lai MS. Importance of ileoscopy during colonoscopy for the early diagnosis of ileal tuberculosis: Report of two cases. Gastrointest Endosc 2001; 53: 813-5
    CrossrefPubMedGoogle Scholar
  • 35 Almadi MA, Ghosh S, Aljebreen AM. Differentiating intestinal tuberculosis from Crohn's disease: A diagnostic challenge. Am J Gastroenterol 2009; 104: 1003-12
    CrossrefPubMedGoogle Scholar
  • 36 Alvares JF, Devarbhavi H, Makhija P, Rao S, Kottoor R. Clinical, colonoscopic, and histological profile of colonic tuberculosis in a tertiary hospital. Endoscopy 2005; 37: 351-6
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Singh V, Kumar P, Kamal J, Prakash V, Vaiphei K, Singh K. Clinicocolonoscopic profile of colonic tuberculosis. Am J Gastroenterol 1996; 91: 565-8
    PubMedGoogle Scholar
  • 38 Shah S, Thomas V, Mathan M, Chacko A, Chandy G, Ramakrishna BS. et al Colonoscopic study of 50 patients with colonic tuberculosis. Gut 1992; 33: 347-51
    CrossrefPubMedGoogle Scholar
  • 39 Marshall JB. Tuberculosis of the gastrointestinal tract and peritoneum. Am J Gastroenterol 1993; 88: 989-99
    PubMedGoogle Scholar
  • 40 Puri AS, Sachdeva S, Mittal VV, Gupta N, Banka A, Sakhuja P. et al Endoscopic diagnosis, management and outcome of gastroduodenal tuberculosis. Indian J Gastroenterol 2012; 31: 125-9
    CrossrefPubMedGoogle Scholar
  • 41 Louis E, Collard A, Oger AF, Degroote E, Aboul Nasr El Yafi FA, Belaiche J. Behaviour of Crohn's disease according to the Vienna classification: Changing pattern over the course of the disease. Gut 2001; 49: 777-82
    CrossrefPubMedGoogle Scholar
  • 42 Farmer RG, Hawk WA, Turnbull Jr RB. Clinical patterns in Crohn's disease: A statistical study of 615 cases. Gastroenterology 1975; 68 (04) Pt 1 627-35
    CrossrefPubMedGoogle Scholar
  • 43 Wilkins T, Jarvis K, Patel J. Diagnosis and management of Crohn's disease. Am Fam Physician 2011; 84: 1365-75
    PubMedGoogle Scholar
  • 44 Goel A, Dutta AK, Pulimood AB, Eapen A, Chacko A. Clinical profile and predictors of disease behavior and surgery in Indian patients with Crohn's disease. Indian J Gastroenterol 2013; 32: 184-9
    CrossrefPubMedGoogle Scholar
  • 45 Stange EF, Travis SP, Vermeire S, Beglinger C, Kupcinkas L, Geboes K. et al European evidence based consensus on the diagnosis and management of Crohn's disease: Definitions and diagnosis. Gut 2006; 55 Suppl 1 i1-15
    CrossrefPubMedGoogle Scholar
  • 46 Rutgeerts PJ. From aphthous ulcer to full-blown Crohn's disease. Dig Dis 2011; 29: 211-4
    CrossrefPubMedGoogle Scholar
  • 47 Lorenz-Meyer H, Malchow H, Miller B, Stock H, Brandes JW. European cooperative Crohn's disease study (ECCDS): Colonoscopy. Digestion 1985; 31: 109-19
    CrossrefPubMedGoogle Scholar
  • 48 Hogan WJ, Hensley GT, Geenen JE. Endoscopic evaluation of inflammatory bowel disease. Med Clin North Am 1980; 64: 1083-102
    CrossrefPubMedGoogle Scholar
  • 49 Meuwissen SG, Pape KS, Agenant D, Oushoorn HH, Tytgat GN. Crohn's disease of the colon. Analysis of the diagnostic value of radiology, endoscopy, and histology. Am J Dig Dis 1976; 21: 81-8
    CrossrefPubMedGoogle Scholar
  • 50 Waye JD. Colitis, cancer, and colonoscopy. Med Clin North Am 1978; 62: 211-24
    CrossrefPubMedGoogle Scholar
  • 51 Oberhuber G, Stangl PC, Vogelsang H, Schober E, Herbst F, Gasche C. Significant association of strictures and internal fistula formation in Crohn's disease. Virchows Arch 2000; 437: 293-7
    CrossrefPubMedGoogle Scholar
  • 52 Annese V, Daperno M, Rutter MD, Amiot A, Bossuyt P, East J. et al European evidence based consensus for endoscopy in inflammatory bowel disease. J Crohns Colitis 2013; 7: 982-1018
    CrossrefPubMedGoogle Scholar
  • 53 Wagtmans MJ, van Hogezand RA, Griffioen G, Verspaget HW, Lamers CB. Crohn's disease of the upper gastrointestinal tract. Neth J Med 1997; 50: S2-7
    CrossrefPubMedGoogle Scholar
  • 54 Rutgeerts P, Onette E, Vantrappen G, Geboes K, Broeckaert L, Talloen L. Crohn's disease of the stomach and duodenum: A clinical study with emphasis on the value of endoscopy and endoscopic biopsies. Endoscopy 1980; 12: 288-94
    Article in Thieme ConnectPubMedGoogle Scholar
  • 55 Diaz L, Hernandez-Oquet RE, Deshpande AR, Moshiree B. Upper gastrointestinal involvement in Crohn disease: Histopathologic and endoscopic findings. South Med J 2015; 108: 695-700
    CrossrefPubMedGoogle Scholar
  • 56 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: 19-21
    PubMedGoogle Scholar
  • 57 Makharia GK, Ghoshal UC, Ramakrishna BS, Agnihotri A, Ahuja V, Chowdhury SD. 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: 750-7
    CrossrefPubMedGoogle Scholar
  • 58 Henriksen M, Jahnsen J, Lygren I, Sauar J, Schulz T, Stray N. et al Change of diagnosis during the first five years after onset of inflammatory bowel disease: Results of a prospective follow-up study (the IBSEN Study). Scand J Gastroenterol 2006; 41: 1037-43
    CrossrefPubMedGoogle Scholar
  • 59 Gisbert JP, Bermejo F, Pérez-Calle JL, Taxonera C, Vera I, McNicholl AG. et al Fecal calprotectin and lactoferrin for the prediction of inflammatory bowel disease relapse. Inflamm Bowel Dis 2009; 15: 1190-8
    CrossrefPubMedGoogle Scholar
  • 60 Rutgeerts P, Geboes K, Vantrappen G, Kerremans R, Coenegrachts JL, Coremans G. Natural history of recurrent Crohn's disease at the ileocolonic anastomosis after curative surgery. Gut 1984; 25: 665-72
    CrossrefPubMedGoogle Scholar
  • 61 Rutgeerts P, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M. Predictability of the postoperative course of Crohn's disease. Gastroenterology 1990; 99: 956-63
    CrossrefPubMedGoogle Scholar
  • 62 Van Assche G, Dignass A, Panes J, Beaugerie L, Karagiannis J, Allez M. et al The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Definitions and diagnosis. J Crohns Colitis 2010; 4: 7-27
    CrossrefPubMedGoogle Scholar
  • 63 Balamurugan R, Venkataraman S, John KR, Ramakrishna BS. PCR amplification of the IS6110 insertion element of Mycobacterium tuberculosis in fecal samples from patients with intestinal tuberculosis. J Clin Microbiol 2006; 44: 1884-6
    CrossrefPubMedGoogle Scholar
  • 64 Morgan MA, Horstmeier CD, DeYoung DR, Roberts GD. Comparison of a radiometric method (BACTEC) and conventional culture media for recovery of mycobacteria from smear-negative specimens. J Clin Microbiol 1983; 18: 384-8
    CrossrefPubMedGoogle Scholar
  • 65 Ye BD, Yang SK, Kim D, Shim TS, Kim SH, Kim MN. et al Diagnostic sensitivity of culture and drug resistance patterns in Korean patients with intestinal tuberculosis. Int J Tuberc Lung Dis 2012; 16: 799-804
    CrossrefPubMedGoogle Scholar
  • 66 Wilson ML. Rapid diagnosis of Mycobacterium tuberculosis infection and drug susceptibility testing. Arch Pathol Lab Med 2013; 137: 812-9
    CrossrefPubMedGoogle Scholar
  • 67 Leung VK, Law ST, Lam CW, Luk IS, Chau TN, Loke TK. et al Intestinal tuberculosis in a regional hospital in Hong Kong: A 10-year experience. Hong Kong Med J 2006; 12: 264-71
    PubMedGoogle Scholar
  • 68 Patel N, Amarapurkar D, Agal S, Baijal R, Kulshrestha P, Pramanik S. et al Gastrointestinal luminal tuberculosis: Establishing the diagnosis. J Gastroenterol Hepatol 2004; 19: 1240-6
    CrossrefPubMedGoogle Scholar
  • 69 Anand BS, Schneider FE, El-Zaatari FA, Shawar RM, Clarridge JE, Graham DY. Diagnosis of intestinal tuberculosis by polymerase chain reaction on endoscopic biopsy specimens. Am J Gastroenterol 1994; 89: 2248-9
    PubMedGoogle Scholar
  • 70 Gan HT, Chen YQ, Ouyang Q, Bu H, Yang XY. Differentiation between intestinal tuberculosis and Crohn's disease in endoscopic biopsy specimens by polymerase chain reaction. Am J Gastroenterol 2002; 97: 1446-51
    CrossrefPubMedGoogle Scholar
  • 71 Bourreille A, Ignjatovic A, Aabakken L, Loftus Jr EV, Eliakim R, Pennazio M. et al Role of small-bowel endoscopy in the management of patients with inflammatory bowel disease: An international OMED-ECCO consensus. Endoscopy 2009; 41: 618-37
    Article in Thieme ConnectPubMedGoogle Scholar
  • 72 Jensen MD, Nathan T, Rafaelsen SR, Kjeldsen J. Diagnostic accuracy of capsule endoscopy for small bowel Crohn's disease is superior to that of MR enterography or CT enterography. Clin Gastroenterol Hepatol 2011; 9: 124-9
    CrossrefPubMedGoogle Scholar
  • 73 Reddy DN, Sriram PV, Rao GV, Reddy DB. Capsule endoscopy appearances of small-bowel tuberculosis. Endoscopy 2003; 35: 99
    Article in Thieme ConnectPubMedGoogle Scholar
  • 74 Cello JP. Capsule endoscopy features of human immunodeficiency virus and geographical diseases. Gastrointest Endosc Clin N Am 2004; 14: 169-77
    CrossrefPubMedGoogle Scholar
  • 75 Triester SL, Leighton JA, Leontiadis GI, Gurudu SR, Fleischer DE, Hara AK. et al A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with non-stricturing small bowel Crohn's disease. Am J Gastroenterol 2006; 101: 954-64
    CrossrefPubMedGoogle Scholar
  • 76 Fidder HH, Nadler M, Lahat A, Lahav M, Bardan E, Avidan B. et al The utility of capsule endoscopy in the diagnosis of Crohn's disease based on patient's symptoms. J Clin Gastroenterol 2007; 41: 384-7
    CrossrefPubMedGoogle Scholar
  • 77 Tukey M, Pleskow D, Legnani P, Cheifetz AS, Moss AC. The utility of capsule endoscopy in patients with suspected Crohn's disease. Am J Gastroenterol 2009; 104: 2734-9
    CrossrefPubMedGoogle Scholar
  • 78 Niv Y, Ilani S, Levi Z, Hershkowitz M, Niv E, Fireman Z. et al Validation of the Capsule Endoscopy Crohn's Disease Activity Index (CECDAI or Niv score): A multicenter prospective study. Endoscopy 2012; 44: 21-6
    Article in Thieme ConnectPubMedGoogle Scholar
  • 79 Gal E, Geller A, Fraser G, Levi Z, Niv Y. Assessment and validation of the new capsule endoscopy Crohn's disease activity index (CECDAI). Dig Dis Sci 2008; 53: 1933-7
    CrossrefPubMedGoogle Scholar
  • 80 Leighton JA, Triester SL, Sharma VK. Capsule endoscopy: A meta-analysis for use with obscure gastrointestinal bleeding and Crohn's disease. Gastrointest Endosc Clin N Am 2006; 16: 229-50
    CrossrefPubMedGoogle Scholar
  • 81 Levesque BG, Cipriano LE, Chang SL, Lee KK, Owens DK, Garber AM. Cost effectiveness of alternative imaging strategies for the diagnosis of small-bowel Crohn's disease. Clin Gastroenterol Hepatol 2010; 8: 261-7 267.e1-4
    CrossrefPubMedGoogle Scholar
  • 82 Mergener K, Ponchon T, Gralnek I, Pennazio M, Gay G, Selby W. et al Literature review and recommendations for clinical application of small-bowel capsule endoscopy, based on a panel discussion by international experts. Consensus statements for small-bowel capsule endoscopy, 2006/2007. Endoscopy 2007; 39: 895-909
    Article in Thieme ConnectPubMedGoogle Scholar
  • 83 Erkelens GW, van Deventer SJ. Endoscopic treatment of strictures in Crohn's disease. Best Pract Res Clin Gastroenterol 2004; 18: 201-7
    PubMedGoogle Scholar
  • 84 Hassan C, Zullo A, De Francesco V, Ierardi E, Giustini M, Pitidis A. et al Systematic review: Endoscopic dilatation in Crohn's disease. Aliment Pharmacol Ther 2007; 26: 1457-64
    CrossrefPubMedGoogle Scholar
  • 85 Gustavsson A, Magnuson A, Blomberg B, Andersson M, Halfvarson J, Tysk C. Endoscopic dilation is an efficacious and safe treatment of intestinal strictures in Crohn's disease. Aliment Pharmacol Ther 2012; 36: 151-8
    CrossrefPubMedGoogle Scholar
  • 86 Zhou ZY, Luo HS. Differential diagnosis between Crohn's disease and intestinal tuberculosis in China. Int J Clin Pract 2006; 60: 212-4
    CrossrefPubMedGoogle Scholar
  • 87 Lee YJ, Yang SK, Byeon JS, Myung SJ, Chang HS, Hong SS. et al Analysis of colonoscopic findings in the differential diagnosis between intestinal tuberculosis and Crohn's disease. Endoscopy 2006; 38: 592-7
    Article in Thieme ConnectPubMedGoogle Scholar
  • 88 Dutta AK, Sahu MK, Gangadharan SK, Chacko A. Distinguishing Crohn's disease from intestinal tuberculosis – A prospective study. Trop Gastroenterol 2011; 32: 204-9
    PubMedGoogle Scholar
  • 89 Zhang T, Fan R, Wang Z, Hu S, Zhang M, Lin Y. et al Differential diagnosis between Crohn's disease and intestinal tuberculosis using integrated parameters including clinical manifestations, T-SPOT, endoscopy and CT enterography. Int J Clin Exp Med 2015; 8: 17578-89
    PubMedGoogle Scholar
  • 90 Yu H, Liu Y, Wang Y, Peng L, Li A, Zhang Y. Clinical, endoscopic and histological differentiations between Crohn's disease and intestinal tuberculosis. Digestion 2012; 85: 202-9
    CrossrefPubMedGoogle Scholar
  • 91 Munot K, Ananthakrishnan AN, Singla V, Benjamin J, Kedia S, Dhingra R. et al Response to trial of antitubercular therapy in patients with ulceroconstrictive intestinal disease and an eventual diagnosis of Crohn's disease. Gastroenterology 2011; 140: S-159
    Google Scholar