Shahid Y, Anis MA, Abid S. Foregut tuberculosis: Too close but miles apart. World J Clin Cases 2024; 12(32): 6517-6525 [PMID: 39554896 DOI: 10.12998/wjcc.v12.i32.6517]
Corresponding Author of This Article
Shahab Abid, FACG, FRCP (Hon), MBBS, PhD, Professor, Department of Medicine, Section of Gastroenterology, Aga Khan University Hospital, Stadium Road, P O Box 3500, Karachi 74800, Pakistan. shahab.abid@aku.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Nov 16, 2024; 12(32): 6517-6525 Published online Nov 16, 2024. doi: 10.12998/wjcc.v12.i32.6517
Foregut tuberculosis: Too close but miles apart
Shahab Abid, Muhammad Aarish Anis, Yumna Shahid
Yumna Shahid, Shahab Abid, Department of Medicine, Section of Gastroenterology, Aga Khan University Hospital, Karachi 74800, Pakistan
Muhammad Aarish Anis, Medical College, Aga Khan University Hospital, Karachi 74800, Pakistan
Author contributions: Shahid Y designed the manuscript, wrote the manuscript and analyzed the data; Anis MA searched the articles and contributed to writing and designing of the manuscript; Abid S reviewed the manuscript, contributed to design of the manuscript and made corrections to the successive versions; All authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflicting interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shahab Abid, FACG, FRCP (Hon), MBBS, PhD, Professor, Department of Medicine, Section of Gastroenterology, Aga Khan University Hospital, Stadium Road, P O Box 3500, Karachi 74800, Pakistan. shahab.abid@aku.edu
Received: March 28, 2024 Revised: June 12, 2024 Accepted: July 31, 2024 Published online: November 16, 2024 Processing time: 179 Days and 10.4 Hours
Abstract
The worldwide burden of tuberculosis (TB) has increased and it can involve virtually any organ of the body. Intestinal TB accounts for about 2% of the cases of TB worldwide. The ileocecal region is the most commonly affected site, and the foregut is rarely involved. The reported incidence is approximately 0.5%. Esophageal TB presents with dysphagia, weight loss, and hematemesis in rare cases. Gastroduodenal TB usually manifests with symptoms such as nausea, vomiting, weight loss, and sometimes with gastric outlet obstruction. Gastroscopy may reveal shallow ulcers in stomach and duodenal deformity when underlying TB is suspected, therefore histopathology plays pivotal role. On computed tomography, duodenal TB typically manifests as duodenal strictures predominantly, accompanied by extrinsic compression, and occasionally as intraluminal mass. But their diagnosis can easily be missed if proper biopsies are not taken and samples are not sent for GeneXpert testing, TB polymerase chain reaction investigation and histopathological analysis. Despite being in close proximity to the lungs, the esophagus and stomach are rare sites of TB. The reasons could be low gastric pH and acidity which does not let mycobacterium grow. But there are various case reports of TB involving the foregut. We have summarized the rare cases of foregut TB in different sections and highlighted the importance of esophagogastroduodenoscopy, histopathology and advanced techniques like endoscopic ultrasound in establishing the diagnosis.
Core Tip: Gastroduodenal tuberculosis (TB) often mimics peptic ulcer disease and malignancies, presenting with symptoms such as gastric outlet obstruction and hematemesis, which necessitate urgent gastroscopic intervention. Differentiating TB from other conditions based solely on endoscopic examination is challenging. Therefore, histopathological analysis and molecular tests like GeneXpert are crucial for an accurate diagnosis. We aim to delve into the intricate details of these unexpected findings, highlighting the diagnostic challenges they present and their potential impact on patient outcomes.
