Differentiation between Crohn's Disease and Intestinal Tuberculosis in Children.

Objectives: To study clinical, endoscopic, radiologic and histopathological features helpful in differentiating Crohn's disease (CD) from intestinal tuberculosis (ITB) in children. Methods: Patients diagnosed to have CD or ITB based on standard recommended criteria were enrolled. Children with inflammatory bowel disease unclassified or suspected ITB or CD with incomplete work-up or lost to follow-up were excluded. The clinical and laboratory (radiology, endoscopy and histology) details of children were analyzed. Results: Twenty cases of ITB (14 [3-17] y) and 23 of CD (11 [1-17] y) were enrolled. Presentation with chronic diarrhea (82% vs. 40%; p = 0.006) and blood in stool (74% vs. 10%; p = 0.001) favored CD while sub-acute intestinal obstruction (20% vs. 0%; p = 0.04) and ascites (30% vs. 0%; p = 0.005) favored ITB. Presence of deep ulcers (61% vs. 30%; p = 0.04), longitudinal ulcers (48% vs. 15%; p = 0.02), involvement of multiple colonic segments (70% vs. 35%; p = 0.02), left sided colon (87% vs. 40%; p = 0.003), extra intestinal manifestations (21.7% vs. 0; p = 0.02), and higher platelet count (3.9 vs. 2.6 lacs/mm3; p = 0.02) favored CD. Isolated ileo-cecal involvement (40% vs. 8.7%; p = 0.03) was a feature of ITB. TB bacilli were demonstrated in 40% ITB cases (colon-6, ascites-1, abdominal lymph node-1). On multivariate analysis, presence of blood in stool [OR: 37.5 (CI: 3.85-365.72), p = 0.002] and left sided colonic involvement [OR: 16.2 (CI: 1.63-161.98), p = 0.02] were independent predictors of CD. Conclusions: Microbiologic confirmation of TB is possible in 40% ITB cases. Presence of blood in stool and left sided colonic involvement are the most important features favoring CD. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2q6Db0m
via IFTTT