Routine diagnosis of intestinal tuberculosis and Crohn's disease in Southern India

Table 1 Inclusion and exclusion criteria for study participants

Criteria
Inclusion criteria
Intestinal tuberculosis (as per modified Paustian’s criteria[31,32]: (a), and one or more of (b) and (c) had to be fulfilled)	(a) Endoscopic apparent intestinal tuberculosis: transverse ulcers, pseudopolyps, involvement of fewer than four intestinal segments, patulous ileo-coecal valve (b) Histological evidence of tubercles/granulomas with caseation necrosis in intestinal biopsies (c) Clinical response to antituberculous chemotherapeutic drug treatment (ATT) trial
Crohn’s disease (as per ECCO guidelines 2010[33] and management consensus of inflammatory bowel disease for the Asia-Pacific region 2006[34])	Exclusion of infectious enterocolitis Endoscopic: ileal disease, rectal sparing, confluent deep linear ulcers, aphthoid ulcers, deep fissures, fistulae, skip lesions (segmental disease), cobble-stoning Histological: focal (discontinuous) chronic (lymphocytes and plasma cells) inflammation and patchy chronic inflammation, focal crypt irregularity (discontinuous crypt distortion) and granulomas (not related to crypt injury) Samples from ileum: irregular villous architecture
Exclusion criteria
Malignancy
HIV positive
Age below 18 yr

Table 2 Symptoms, signs and disease associated factors of intestinal tuberculosis and Crohn’s disease n (%)

Symptoms, signs and factors	ITB (n = 38)	CD (n = 37)	P value
Duration of illness prior to care (mo), median	6	6	0.581
Min-Max	0-60	1-78
Body mass index, median	19.6	22.7	0.011
Min-Max	11.2-26.0	15.6-31.2
Waist circumference (cm), median (inter quartile range)	77 (11)	80 (15)	0.821
Change in bowel habit	28/37 (76)	34 (92)	0.112
Weight loss in history of current complaint	27/37 (73)	14 (38)	< 0.012
Malaise in history of current complaint	23/37 (62)	32 (87)	0.032
Abdominal pain in history of current complaint	35 (92)	33 (89)	0.712
Nausea in history of current complaint	20/37 (54)	31 (84)	0.012
Recent fever	17/37 (47)	9/36 (25)	0.062
Cachexia at examination	22/36 (61)	21 (57)	0.712
Current watery diarrhoea	21/33 (64)	12/36 (33)	0.012
Daily bowel evacuations, median, max (inter quartile range)	3 (3)	3 (0)	0.241
Pain in right lower abd. quadrant on exam	15/28 (54)	27/30 (90)	< 0.012

¹Mann Whitney Wilcoxon Test;

²Pearson χ² Test OR Fischer’s exact test if n in any cell < 5. ITB: Intestinal tuberculosis; CD: Crohn’s disease.

Table 3 Laboratory, endoscopic and histopathological variables in intestinal tuberculosis and Crohn’s disease

Clinical variables	ITB(n = 38)	CD(n = 37)	P value
CRP (mg/L), median	10.7	4.3	0.131
Min-max	0.2-70.5	0.3-49.8
Features on ileocolonoscopy, n endoscopy reports	31/38	37
Localised intestinal inflammation, n	12	4	0.012
3 or more inflamed intestinal segments, n	9	27	< 0.012
Aphtous ulcers, n	12	16	0.712
Deep ulcers, n	19	24	0.902
Mucosal nodularity, n	17	2	< 0.012
Histopathological evidence of granulomas(s), n	10/30	2/35	< 0.012

¹Mann Whitney Wilcoxon Test;

²Pearson χ² Test OR Fischer’s exact test if n in any cell < 5. ITB: Intestinal tuberculosis; CD: Crohn’s disease.

Table 4 Demographic data of intestinal tuberculosis and Crohn’s disease patients n (%)

Demographic data	ITB(n = 38)	CD(n = 37)	P value
Age, median	33	33	0.621
(min-max)	(21-68)	(18-76)
Male gender	22 (58)	24 (65)	0.542
Average monthly household income (€), median	64	114	0.101
(min-max)	(4-508)	(25-953)
Urban domicile	15 (42)	24 (65)	0.052
High school degree or higher	20 (53)	27 (73)	0.072

¹Mann Whitney Wilcoxon Test;

²Pearson χ² Test OR Fischer’s exact test if n in any cell < 5. ITB: Intestinal tuberculosis; CD: Crohn’s disease.

Table 5 Multiple logistic regression analysis of symptoms, signs and endoscopic features of intestinal tuberculosis and Crohn’s disease

	P value	OR	95%CI	Associated with
Multiple logistic regression model 1
Weight loss	0.003	8.6	2.1-35.6	ITB
Pain in right lower abdominal quadrant on examination	0.005	10.1	2.0-51.3	CD
Multiple logistic regression model 2
Mucosal nodularity	0.001	18.9	3.5-102.8	ITB
Multi-segment involvement (3 or more)	0.005	5.9	1.7-20.6	CD

ITB: Intestinal tuberculosis; CD: Crohn’s disease.