1/ n Differrentiating intestinal TB and Crohn disease can be tough be we have made progress.... #Tuberculosis #IBD journals.lww.com/eurojgh/Abstra… 
2/nMicrobiological diagnosis of ITB is possible in only 20-40% cases. Discriminating Intestinal TB and Crohn disease is tough and most clinicians in endemic countries encounter this confusion commonly 😕. . #Tuberculosis
3/n Then how to differrentiate: When in doubt, we start ATT. We know it could be Crohn's but the consequences of starting immune-suppressing treatment in Intestinal TB could be disastrous. tandfonline.com/doi/full/10.10…
4/n Usually we gave ATT for six months and looked for response to ATT. How to define response???
Clinical symptoms are unreliable. Patients with TB could continue to symptomatic with ATT because of strictures while ATT could provide clinical response in Crohns.
Clinical symptoms are unreliable. Patients with TB could continue to symptomatic with ATT because of strictures while ATT could provide clinical response in Crohns.
5/n Then we started looking for end of therapy endoscopic/ mucosal response. The ulcers of ITB heal with ATT while ulcers of CD persist. But is it OK to treat CD with antimycobacterial therapy ❓
6/n There is conflicting evidence regarding use of antimycobacetrial therapy in Crohn disease and people have attempted using it in CD gastrojournal.org/article/S0016-…
7/n Growing evidence suggests that ATT in patients with CD not only delays the diagnosis but predispose to stenotic outcomes. Hence the need to know early what we are dealing with pubmed.ncbi.nlm.nih.gov/29572889/
8/n We found that ulcer healing could be sought as early as at 2 months of ATT. We called it Early mucosal response. If ulcers heal: it is ITB and continue ATT. If ulcers dont healp: Consider Crohn disease or drug resistance onlinelibrary.wiley.com/doi/full/10.11…
9/n But repeating an colonoscopy ! Patients dont like it, adds costs and risk. Could we use some non-invasive markers fro early response? We tried C-reactive protein... dldjournalonline.com/article/S1590-…
10/n CRP seemed to be helpful, the declines mimicked mucosal responses but there were problems: A substantial numbers had normal CRP at baseline and some decline ocurred even in Crohn disease. Could Calprotectin be better ?
11/n This brings us to the comparison of serial Calprotectin and CRP. Fecal Calprotectin is better to predict mucosal healing, also combination could be much better. journals.lww.com/eurojgh/Abstra…
12/n There are still problems. Fecal calprotectin levels at baseline depend on severity of disease ...we had normal or slightly elevated levels in some patients at baseline... at least one patient had normal CRP and calprotectin at baseline.
13/n Noninvasive assessment for early mucosal response is helpful (unless baseline levels are normal). If initially elevated levels decline we could avoid repeat colonoscopy. If levels plataeu or increase : Consider Crohn disease or drug resistance and rpt colonoscopy. Ends/
@threadreaderapp please unroll
