Thread by @drvishal82

@DCharabaty @MondayNightIBD @southasianIBD @P_DeepakIBDMD @IBDimmunology @nehagastrord @ibdesis @ownyourcrohns @FITWITMD @crohnsbabble @rebelliousgut @ibdseb @drsumitbhatia @DrAnjaliPandit A1/n One of the most difficult clinical situations which a clinician could encounter: the two entities are remarkably similar
At our center almost half of such situations the underlying condition is ITB and in the rest half CD
Crossed fingers

@DCharabaty @MondayNightIBD @southasianIBD @P_DeepakIBDMD @IBDimmunology @nehagastrord @ibdesis @ownyourcrohns @FITWITMD @crohnsbabble @rebelliousgut @ibdseb @drsumitbhatia @DrAnjaliPandit @deepakjgastro @shivaramsingh @drroshanag @stevenbollipo @drkeithsiau @doctorboletoh @Rajatgastro @KailashKolhe @DrAnuraagJ A 2/n ITB versus CD
Clinical clues may offer some clarity .....but never a certainty regarding the underlying cause of the symptoms @realTBpeople
#Tuberculosis #IBD
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@DCharabaty @MondayNightIBD @southasianIBD @P_DeepakIBDMD @IBDimmunology @nehagastrord @ibdesis @ownyourcrohns @FITWITMD @crohnsbabble @rebelliousgut @ibdseb @drsumitbhatia @DrAnjaliPandit @deepakjgastro @shivaramsingh @drroshanag @stevenbollipo @drkeithsiau @doctorboletoh @Rajatgastro @KailashKolhe @DrAnuraagJ @realTBpeople @anupam_gastro @UjjwalSonika @DrAshokGastro @vandana_midha @ashok_doctor @drakashmathur @Khanna_S @miNitinjagtap @jalpa_devi @DharJahnvi A 3/n
In endemic regions, use of indirect tests (Tuberculin skin test and IGRAs) does not help in discrimination as they may be positive even in those with CD.

ASCA, in Indian studies, has not been found to be helpful . We donot use it at all

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Computed tomography may help in suggesting the underlying diagnosis- more importantly, it helps guide the further evaluation and tissue acquisition

Necrotic lymph nodes are almost never seen with CD @PankajG55222170
@SRajesh_IR
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@DCharabaty @MondayNightIBD @southasianIBD @P_DeepakIBDMD @IBDimmunology @nehagastrord @ibdesis @ownyourcrohns @FITWITMD @crohnsbabble @rebelliousgut @ibdseb @drsumitbhatia @DrAnjaliPandit @deepakjgastro @shivaramsingh @drroshanag @stevenbollipo @drkeithsiau @doctorboletoh @Rajatgastro @KailashKolhe @DrAnuraagJ @realTBpeople @anupam_gastro @UjjwalSonika @DrAshokGastro @vandana_midha @ashok_doctor @drakashmathur @Khanna_S @miNitinjagtap @jalpa_devi @DharJahnvi @SamirGadepalli @DrSamirAShah1 @SunandaKaneMD @UmaMahadevanIBD @BilalMohammadMD @AsadurRahman87 @ShimaghavimiMD @ibdmd_kaur @IBDMD @PankajG55222170 @SRajesh_IR @DrKaushalMadan1 @mantaj_brar @doc_zubin @docgovind @venky72 A 5/n
Endoscopic findings are never specific

But do offer some clues

Look for orientation of ulcers and site of involvement

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@DCharabaty @MondayNightIBD @southasianIBD @P_DeepakIBDMD @IBDimmunology @nehagastrord @ibdesis @ownyourcrohns @FITWITMD @crohnsbabble @rebelliousgut @ibdseb @drsumitbhatia @DrAnjaliPandit @deepakjgastro @shivaramsingh @drroshanag @stevenbollipo @drkeithsiau @doctorboletoh @Rajatgastro @KailashKolhe @DrAnuraagJ @realTBpeople @anupam_gastro @UjjwalSonika @DrAshokGastro @vandana_midha @ashok_doctor @drakashmathur @Khanna_S @miNitinjagtap @jalpa_devi @DharJahnvi @SamirGadepalli @DrSamirAShah1 @SunandaKaneMD @UmaMahadevanIBD @BilalMohammadMD @AsadurRahman87 @ShimaghavimiMD @ibdmd_kaur @IBDMD @PankajG55222170 @SRajesh_IR @DrKaushalMadan1 @mantaj_brar @doc_zubin @docgovind A1- 6/n
Histology plays an important role and on some occasions may clinch the diagnosis

Findings very suggestive of ITB:
Confluent granulomas
Caseating necrosis
Ulcers lined by histiocytes

@aravindcmc88

@DCharabaty @MondayNightIBD @southasianIBD @P_DeepakIBDMD @IBDimmunology @nehagastrord @ibdesis @ownyourcrohns @FITWITMD @crohnsbabble @rebelliousgut @ibdseb @drsumitbhatia @DrAnjaliPandit @deepakjgastro @shivaramsingh @drroshanag @stevenbollipo @drkeithsiau @doctorboletoh @Rajatgastro @KailashKolhe @DrAnuraagJ @realTBpeople @anupam_gastro @UjjwalSonika @DrAshokGastro @vandana_midha @ashok_doctor @drakashmathur @Khanna_S @miNitinjagtap @jalpa_devi @DharJahnvi @SamirGadepalli @DrSamirAShah1 @SunandaKaneMD @UmaMahadevanIBD @BilalMohammadMD @AsadurRahman87 @ShimaghavimiMD @ibdmd_kaur @IBDMD @PankajG55222170 @SRajesh_IR @DrKaushalMadan1 @mantaj_brar @doc_zubin A1- 7/n Low Microbiological Positivity is the Achilles heel in diagnosis of ITB
Hope development of sensitive microbiological diagnostics, will help secure a firmer diagnosis in future. Till then,a substantial number need therapeutic trial of ATT
@drroshanag @KusumSh94603109

@DCharabaty @MondayNightIBD @southasianIBD @P_DeepakIBDMD @IBDimmunology @nehagastrord @ibdesis @ownyourcrohns @FITWITMD @crohnsbabble @rebelliousgut @ibdseb @drsumitbhatia @DrAnjaliPandit @deepakjgastro @shivaramsingh @drroshanag @stevenbollipo @drkeithsiau @doctorboletoh @Rajatgastro @KailashKolhe @DrAnuraagJ @realTBpeople @anupam_gastro @UjjwalSonika @DrAshokGastro @vandana_midha @ashok_doctor @drakashmathur @Khanna_S @miNitinjagtap @jalpa_devi @DharJahnvi @SamirGadepalli @DrSamirAShah1 @SunandaKaneMD @UmaMahadevanIBD @BilalMohammadMD @AsadurRahman87 @ShimaghavimiMD @ibdmd_kaur @IBDMD @PankajG55222170 @SRajesh_IR @DrKaushalMadan1 @mantaj_brar @doc_zubin @KusumSh94603109 A1-8/n Does mathematical sense work when clinical sense doesn’t?

At least it provides the clinicians and patients with some estimates of the underlying probability with the available information
@ibddoctor
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@DCharabaty @MondayNightIBD @southasianIBD @P_DeepakIBDMD @IBDimmunology @nehagastrord @ibdesis @ownyourcrohns @FITWITMD @crohnsbabble @rebelliousgut @ibdseb @drsumitbhatia @DrAnjaliPandit @deepakjgastro @shivaramsingh @drroshanag @stevenbollipo @drkeithsiau @doctorboletoh @Rajatgastro @KailashKolhe @DrAnuraagJ @realTBpeople @anupam_gastro @UjjwalSonika @DrAshokGastro @vandana_midha @ashok_doctor @drakashmathur @Khanna_S @miNitinjagtap @jalpa_devi @DharJahnvi @SamirGadepalli @DrSamirAShah1 @SunandaKaneMD @UmaMahadevanIBD @BilalMohammadMD @AsadurRahman87 @ShimaghavimiMD @ibdmd_kaur @IBDMD @PankajG55222170 @SRajesh_IR @DrKaushalMadan1 @mantaj_brar @doc_zubin A1- 9/n

In endemic regions therapeutic trial with ATT still has a value and role in providing the final diagnosis when nothing else seems to work

Look for the healing of ulcers @ 2 months
@DrAnuraagJ @JhaDayakrishna

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