Meta-Analysis
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World J Gastroenterol. Nov 28, 2013; 19(44): 8133-8140
Published online Nov 28, 2013. doi: 10.3748/wjg.v19.i44.8133
Effectiveness of interferon-gamma release assays for differentiating intestinal tuberculosis from Crohn’s disease: A meta-analysis
Wen Chen, Jun-Hua Fan, Wei Luo, Peng Peng, Si-Biao Su
Wen Chen, Department of Educational Administration, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Jun-Hua Fan, Wei Luo, Peng Peng, Si-Biao Su, Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Author contributions: Su SB designed the study, searched the databases, extracted the data, analyzed the results, and wrote the manuscript; Chen W helped design the study, searched the databases, and wrote and revised the manuscript; Fan JH formulated the research question, and helped with database searches and analysis; Luo W and Peng P helped design the data abstraction form and served as second reviewers in extracting the data; all authors have read and approved the final manuscript.
Correspondence to: Dr. Si-Biao Su, Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, No. 22, Shuangyong Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China. susibiao@gmail.com
Telephone: +86-771-5356501 Fax: +86-771-5356585
Received: August 5, 2013
Revised: September 15, 2013
Accepted: October 17, 2013
Published online: November 28, 2013
Processing time: 127 Days and 16.9 Hours
Abstract

AIM: To investigate the clinical usefulness of interferon-gamma release assays (IGRAs) in the differential diagnosis of intestinal tuberculosis (ITB) from Crohn’s disease (CD) by meta-analysis.

METHODS: A systematic search of English language studies was performed. We searched the following databases: Medline, Embase, Web of Science and the Cochrane Library. The Standards for Reporting Diagnostic Accuracy initiative and Quality Assessment for Studies of Diagnostic Accuracy tool were used to assess the methodological quality of the studies. Sensitivity, specificity, and other measures of the accuracy of IGRAs in the differential diagnosis of ITB from CD were pooled and analyzed using random-effects models. Receiver operating characteristic curves were applied to summarize overall test performance. Two reviewers independently judged study eligibility while screening the citations.

RESULTS: Five studies met the inclusion criteria. The average inter-rater agreement between the two reviewers for items in the quality checklist was 0.95. Analysis of IGRAs for the differential diagnosis of ITB from CD produced summary estimates as follows: sensitivity, 0.74 (95%CI: 0.68-0.80); specificity, 0.87 (95%CI: 0.82-0.90); positive likelihood ratio, 5.98 (95%CI: 3.79-9.43); negative likelihood ratio, 0.28 (95%CI: 0.18-0.43); and diagnostic odds ratio, 26.21 (95%CI: 14.15-48.57). The area under the curve was 0.92. The evaluation of publication bias was not significant (P = 0.235).

CONCLUSION: Although IGRAs are not sensitive enough, they provide good specificity for the accurate diagnosis of ITB, which may be helpful in the differential diagnosis of ITB from CD.

Keywords: Intestinal tuberculosis, Crohn’s disease, Interferon-gamma, Meta-analysis

Core tip: The misdiagnosis rate between Crohn’s disease (CD) and intestinal tuberculosis (ITB) is 50%-70%. Interferon-gamma release assays (IGRAs) have been used mainly to identify latent tuberculosis infection in patients in several areas and countries. However, the clinical usefulness of IGRAs in the differential diagnosis of ITB from CD is unknown. This is the first study to investigate the clinical usefulness of IGRAs in the differential diagnosis of ITB from CD by meta-analysis. IGRAs provided good specificity for ITB, and should be helpful in the differential diagnosis of ITB from CD.