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Combined identifying granuloma and biopsy culture is useful for diagnosing intestinal tuberculosis

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purposes

Differential diagnosis of intestinal tuberculosis (ITB) and inflammatory bowel disease (IBD) can be difficult, but many gastroenterologists may only perform biopsy for pathology and their own experience. This study aimed to identify optimal sample collection and pathogen detection methods for diagnosing ITB.

Methods

A cohort of 182 patients (50 had ITB and 132 had IBD or other colonic diseases) who underwent colonoscopy was analyzed. Sensitivity of acid-fast bacilli (AFB), culture, polymerase chain reaction (PCR), and granuloma pathology on hematoxylin and eosin stain for diagnosing ITB were compared in relation to biopsy, endoscopic aspirated intestinal fluid, or standard stool evaluations. We also evaluated which combination offered the highest yield to diagnose intestinal tuberculosis in addition to granuloma pathology.

Results

Between ITB and non-ITB, no significant differences were observed in age, sex, and nationality. In biopsy analysis, sensitivity was as follows: culture (50 %), AFB (38 %), PCR (25 %), granuloma pathology (51 %), and caseous granuloma (8.2 %), while specificity of granuloma pathology was low (80 %), compared to other tests. In intestinal fluid analysis, sensitivity was as follows: culture (46 %), AFB (42 %), and PCR (35 %). In standard stool analysis, sensitivity was as follows: culture (47 %), AFB (37 %), and PCR (23 %). Granuloma pathology plus biopsy culture offered the highest combination sensitivity (77 %), significantly (P < 0.01) higher than that for granuloma pathology alone (51 %).

Conclusions

When encountering suspected intestinal tuberculosis or IBD on colonoscopy, biopsy culture is recommended in addition to pathological assessment of granuloma. This diagnostic strategy will lead to accurate differential diagnosis of colonic disease, facilitating appropriate treatment.

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Acknowledgments

We wish to express our gratitude to Clinical Research Coordinators Hisae Kawashiro, Sawako Iijima, Yoko Tanigawa, Aiko Gotanda, and Yaeko Sawada for their help with the data collection.

Conflict of interest

The authors declare no conflict of interest.

Source of funding

This study was partly supported by a grant from the National Center for Global Health and Medicine (26A-201).

Authors’ contributions

Nagata N designed the study; Sekine K, Nagata N, and Shindo T collected the clinical information and were the main authors of the manuscript; Shimbo T performed the statistical analysis; Sekine K, and Shindo T collected the clinical information; Akiyama J, Nagata N, Shimbo T, Mizokami M, and Uemura N edited the manuscript. All authors approved the final draft submitted.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan

    Katsunori Sekine, Naoyoshi Nagata & Junichi Akiyama

  2. Respiratory Medicine, National Center for Global Health and Medicine (NCGM), Tokyo, Japan

    Takuma Shindo & Eriko Morino

  3. Clinical Research and Informatics, National Center for Global Health and Medicine, Tokyo, Japan

    Takuro Shimbo

  4. Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan

    Masashi Mizokami

  5. Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan

    Naomi Uemura

Authors
  1. Katsunori Sekine
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  2. Naoyoshi Nagata
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  3. Takuma Shindo
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  4. Eriko Morino
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  5. Takuro Shimbo
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  6. Junichi Akiyama
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  7. Masashi Mizokami
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  8. Naomi Uemura
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Corresponding author

Correspondence to Naoyoshi Nagata.

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Sekine, K., Nagata, N., Shindo, T. et al. Combined identifying granuloma and biopsy culture is useful for diagnosing intestinal tuberculosis. Int J Colorectal Dis 30, 939–945 (2015). https://doi.org/10.1007/s00384-015-2208-8

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  • DOI: https://doi.org/10.1007/s00384-015-2208-8

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