CHALLENGES IN DIFFERENTIATING GASTROINTESTINAL TUBERCULOSIS AND CROHNS DISEASE IN A TERTIARY CARE HOSPITAL

Background: Tuberculosis (TB) still continues to be a global health concern. In India, where Crohn's disease (CD) cases are on rise, it is difcult to diagnose and manage gastrointestinal tuberculosis (GITB).Final diagnosis is based on a combination of the clinical history with endoscopic studies, culture and PCR, biopsy pathology, radiological investigations and response to therapy.Early mucosal response at two-three months is a marker of response. Early differentiation is important in preventing the delay in the diagnosis and avoiding a complicated course. Aim of the Study: To identify the differentiating factors between GITB and CD. To correlate between important patient characteristics, symptoms, serology, imaging, colonoscopy, histology, response to treatment and nal diagnosis. Patients who have feature Methods: s of both TB and CD and have difculties in diagnosis, managing at our centre are included. Patients was diagnosed presumably with TB and CD based on symptoms, serology, imaging, colonoscopy, histology, response to treatment and nal diagnosis was based on response to therapy.A total of 30 patients were analyzed. Results: Mean VF/SC was 0.54. 9(30%) patients were found to have VF/SC more than 0.63 and 8 (88%) of these turned out to be CD. Stricture was seen in total 13 (43%) patients. >3cm stricture was seen in 9 (30%) patients and <3cm in 4 (13%). Final diagnosis of CD was made in 7 (77%) of these who have >3cm stricture and in 1(20%) who have <3cm stricture.Final diagnosis of TB was made in 18 (64%) patients and CD in 12 (36%). Conclusions: Diagnosis is challenging because of paucity of bacilli in samples acquired and is aided by serology and imaging.VF/SC ratio and long segment stricture (>3cm) are two features in imaging which may distinguish CD from TB with high specicity.