Infectious diseases of the upper gastrointestinal tract are rare, but certain bacteria including Treponema pallidum and Mycobacterium tuberculosis may infect the esophagus, stomach, and duodenum even in an immunocompetent individual. Gastric syphilis is difficult to diagnose because it presents with non-specific symptoms and diverse endoscopic findings. Nevertheless, gastric syphilis should be considered in the differential diagnosis when a patient presents with chronic inflammatory gastric lesions such as multiple erosive/ulcerative lesions and stricture or with other evidence of syphilis. Histological evaluation and specific serological tests should be performed if syphilis is suspected. Esophageal and gastroduodenal tuberculosis also exhibits non-specific clinical manifestations. The diagnosis is confirmed by mucosal biopsy or aspiration cytology revealing the presence of caseating granulomata and/or acid-fast bacilli. Mycobacterial culture and polymerase chain reaction should be incorporated into routine diagnostic studies to improve the diagnostic sensitivity. The diagnosis of tuberculosis is occasionally confirmed indirectly by an excellent response of the patient to anti-tubercular therapy.
Bacteria ; Biopsy ; Communicable Diseases ; Constriction, Pathologic ; Diagnosis ; Diagnosis, Differential ; Duodenum ; Esophagus ; Humans ; Mycobacterium tuberculosis ; Polymerase Chain Reaction ; Serologic Tests ; Stomach ; Syphilis ; Treponema pallidum ; Tuberculosis ; Upper Gastrointestinal Tract

Gastric tuberculosis accounts for approximately 2% of all cases of gastrointestinal tuberculosis. Diagnosis of gastric tuberculosis is challenging because it can present with various clinical, endoscopic, and radiologic features. Tuberculosis manifesting as a gastric subepithelial tumor is exceedingly rare; only several dozen cases have been reported. A 30-year-old male visited emergency room of our hospital with hematemesis and melena. Abdominal CT revealed a 2.5 cm mass in the gastric antrum, and endoscopy revealed a subepithelial mass with a visible vessel at its center on gastric antrum. Primary gastric tuberculosis was diagnosed by surgical wedge resection. We report a rare case of gastric tuberculosis mimicking a subepithelial tumor with acute gastric ulcer bleeding.
Adult ; Diagnosis ; Emergency Service, Hospital ; Endoscopy ; Gastrointestinal Hemorrhage ; Hematemesis ; Hemorrhage* ; Humans ; Male ; Melena ; Pyloric Antrum ; Stomach Ulcer ; Tomography, X-Ray Computed ; Tuberculosis* ; Tuberculosis, Gastrointestinal

Intestinal tuberculosis is an infection of the gastrointestinal tract by the Mycobacterium tuberculosis complex. To the best of our knowledge, solitary intestinal tuberculosis accompanied by intestinal obstruction, particularly in the middle of the small intestine, is extremely rare. We report a case of solitary jejunal tuberculosis in a 49-year-old man with no underlying disease. He was admitted a few days after the onset of diffuse abdominal discomfort. Upon evaluation, we initially considered a malignancy of the distal jejunum with ileus due to the presence of a mass. Therefore, he underwent laparoscopic resection of the small bowel. Unexpectedly, the histologic specimen showed a chronic caseating granulomatous lesion with acid-fast bacilli. Ultimately, he was diagnosed with solitary jejunal tuberculosis. He was successfully treated with anti-tuberculosis drugs without any complications.
Gastrointestinal Tract ; Humans ; Ileus ; Immunocompetence ; Intestinal Obstruction* ; Intestine, Small ; Jejunum ; Middle Aged ; Mycobacterium tuberculosis ; Tuberculosis* ; Tuberculosis, Gastrointestinal

Abdominal computed tomography (CT) can noninvasively image the entire gastrointestinal tract and assess extraintestinal features that are important in differentiating Crohn's disease (CD) and intestinal tuberculosis (ITB). The present meta-analysis pooled the results of all studies on the role of CT abdomen in differentiating between CD and ITB. We searched PubMed and Embase for all publications in English that analyzed the features differentiating between CD and ITB on abdominal CT. The features included comb sign, necrotic lymph nodes, asymmetric bowel wall thickening, skip lesions, fibrofatty proliferation, mural stratification, ileocaecal area, long segment, and left colonic involvements. Sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio (DOR) were calculated for all the features. Symmetric receiver operating characteristic curve was plotted for features present in >3 studies. Heterogeneity and publication bias was assessed and sensitivity analysis was performed by excluding studies that compared features on conventional abdominal CT instead of CT enterography (CTE). We included 6 studies (4 CTE, 1 conventional abdominal CT, and 1 CTE+conventional abdominal CT) involving 417 and 195 patients with CD and ITB, respectively. Necrotic lymph nodes had the highest diagnostic accuracy (sensitivity, 23%; specificity, 100%; DOR, 30.2) for ITB diagnosis, and comb sign (sensitivity, 82%; specificity, 81%; DOR, 21.5) followed by skip lesions (sensitivity, 86%; specificity, 74%; DOR, 16.5) had the highest diagnostic accuracy for CD diagnosis. On sensitivity analysis, the diagnostic accuracy of other features excluding asymmetric bowel wall thickening remained similar. Necrotic lymph nodes and comb sign on abdominal CT had the best diagnostic accuracy in differentiating CD and ITB.
Abdomen ; Animals ; Colon ; Comb and Wattles ; Crohn Disease* ; Diagnosis ; Gastrointestinal Tract ; Humans ; Lymph Nodes ; Odds Ratio ; Population Characteristics ; Publication Bias ; ROC Curve ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Tuberculosis*

Crohn's disease (CD) is a chronic relapsing and remitting inflammatory disease of the gastrointestinal tract. CD is rare in Taiwan and other Asian countries, but its prevalence and incidence have been steadily increasing. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of CD taking into account currently available evidence and the expert opinion of the committee. Thorough clinical, endoscopic, and histological assessments are required for accurate diagnosis of CD. Computed tomography and magnetic resonance imaging are complementary to endoscopic evaluation for disease staging and detecting complications. The goals of CD management are to induce and maintain remission, reduce the risk of complications, and improve quality of life. Corticosteroids are the mainstay for inducing re-mission. Immunomodulating and biologic therapies should be used to maintain remission. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to treatment and receive regular surveillance for cancer. These consensus statements are based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of patients with CD in Taiwan.
Adrenal Cortex Hormones ; Asian Continental Ancestry Group ; Biological Therapy ; Consensus* ; Crohn Disease* ; Diagnosis ; Disease Management ; Expert Testimony ; Gastrointestinal Tract ; Hepatitis B virus ; Humans ; Incidence ; Inflammatory Bowel Diseases* ; Magnetic Resonance Imaging ; Prevalence ; Quality of Life ; Taiwan* ; Tuberculosis

BACKGROUND/AIMS: In some Western countries, up to 50% of patients with ankylosing spondylitis (AS) have subclinical gut inflammation. This study was conducted to evaluate the prevalence and severity of gut inflammation and to determine clinical factors associated with colonic inflammation in Korean AS patients who performed ileocolonoscopy without evidence of established inflammatory bowel diseases before. METHODS: One hundred and eight AS patients who underwent ileocolonoscopy were included in this study. Patients were divided into two groups based on gross ileocolonoscopic findings; patients with inflammatory lesions, and patients without inflammatory lesions. RESULTS: Inflammatory lesions in ileocolonoscopic findings were found in 40 patients. The Ankylosing Spondylitis Disease Activity Score C-reactive protein was higher in the group with inflammatory lesions and gut lesions were found often in the terminal ileum. The risk of inflammatory lesions was higher for AS patients whose symptoms required ileocolonoscopy than for AS patients who underwent routine ileocolonoscopy screening (odds ratio, 3.96). However, abnormal lesions were detected also in 17.6% of the patients who underwent ileocolonoscopy for routine screening and most of them were erosion and ulcer. Among patients with inflammatory lesions (n = 40), 23 showed subclinical gut inflammation associated with AS and 17 were diagnosed finally as Crohn's disease (n = 12), intestinal tuberculosis (n = 4), and ulcerative colitis (n = 1). CONCLUSIONS: Our findings suggest that ileocolonoscopy might be recommended regularly in AS patients even without gastrointestinal symptoms, especially in the patients with high AS activity.
C-Reactive Protein ; Colitis, Ulcerative ; Colon ; Colonoscopy ; Crohn Disease ; Gastrointestinal Diseases ; Humans ; Ileum ; Inflammation ; Inflammatory Bowel Diseases ; Mass Screening ; Prevalence ; Retrospective Studies* ; Spondylitis, Ankylosing* ; Tuberculosis ; Ulcer

OBJECTIVE: To determine the prevalence, demographic, clinical profile, diagnostic and treatment outcomes of adult patients diagnosed with disseminated tuberculosis

METHODS: This is a cross sectional study of patients referred to the UP-PGH TB DOTS clinic with a diagnosis of disseminated TB from January 2011 to December 2015.

RESULTS: The prevalence of disseminated tuberculosis was 1.7 %.Mean age at diagnosis was 33.9 years (range 19-64 years) with a male: female ratio of 1:1. The most common comorbidity was HIV (5.8%). The mean duration of symptoms before initial consult was 281 days (SD 510.7). The most common presenting symptoms were abdominal pain (19%), back pain (13%), and abdominal enlargement (11%). The lungs (86%) are still the most commonly involved site, followed by the gastrointestinal tract (22%) and the vertebra (27%). Majority were started with Category I treatment regimen (54%, 37 patients). Of the 68 patients, only 16% (11 patients) continued follow-up at PGH; all had documented treatment completion.

CONCLUSION: Patients with disseminated tuberculosis are young and majority had no comorbid illness. They have long latency of symptoms prior to diagnosis, and usually present with nonpulmonary symptoms despite high evidence of pulmonary involvement. To date, this is the largest local study on disseminated TB known to the authors.

Human ; Male ; Female ; Middle Aged ; Adult ; Comorbidity ; Abdomen ; Treatment Outcome ; Abdominal Pain ; Gastrointestinal Tract ; Tuberculosis ; Back Pain ; Hiv Infections

BACKGROUNDTuberculosis (TB) remains a worldwide problem. Intestinal TB (ITB) constitutes a major public health problem in developing countries and has been associated with significant morbidity and mortality. The aim of this study was to characterize the clinical, radiological, endoscopic, and pathological features of ITB and to define the strategy for establishing the diagnosis.

METHODSA retrospective study (from January 2000 to June 2015) was carried out in Peking Union Medical College Hospital and all hospitalized cases were diagnosed as ITB during the study period were included. The relevant clinical information, laboratory results, microbiological, and radiological investigations were recorded.

RESULTSOf the 85 cases, 61 cases (71.8%) were ranged from 20 to 50 years. The ileocecal region was involved in about 83.5% (71/85) of patients. About 41.2% (35/85) of patients had co-existing extra ITB, especially active pulmonary TB. Abdominal pain (82.4%) was the most common presenting symptom followed by weight loss (72.9%) and fever (64.7%). Both T-cell spot of TB test (T-SPOT.TB) and purified protein derivatives (PPD) tests were performed in 26 patients: 20 (76.9%) positive T-SPOT.TB and 13 (50.0%) positive PPD were detected, with a statistical significant difference (P = 0.046). Twenty cases (23.5%) were histopathology and/or pathogen confirmed TB; 27 cases (31.8%) were diagnosed by clinical manifestation consistent with ITB and evidence of active extra ITB; 38 cases (44.7%) were diagnosed by good response to diagnostic anti-TB therapy.

CONCLUSIONSITB is difficult to diagnose even with modern medical techniques due to its nonspecific clinical and laboratory features. At present, combination of clinical, endoscopic, radiological, and pathological features continues to be the key to the diagnosis of ITB.

Adult ; Clinical Laboratory Techniques ; methods ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Peritonitis, Tuberculous ; diagnosis ; Retrospective Studies ; Tuberculosis, Gastrointestinal ; diagnosis ; Tuberculosis, Pulmonary ; diagnosis ; Young Adult

INTRODUCTION: In the Philippines, a diagnosis of pulmonary tuberculosis  is  very  common  especially  in  the  presence of sputum findings positive for Acid Fast Bacilli (AFB).  But it should be kept in mind that not all Mycobacterium are tuberculosis(TB).A  previous  study  done  at  the  University of Santo Tomas (UST) Hospital from 2003 to 2009 showed a 2.17% incidence of Mycobacterium other than tuberculosis (MOTT). However, due to its growing correlation with the Human Immunedeficiency Virus (HIV), updated incidence rates  are  warranted.Likewise,the importance of culture in  the  right  diagnosis  of  diseases  should  always  be  emphasized.
OBJECTIVES: The study aimed to determine the incidence of  MOTT  in  a  tertiary  hospital  in  Manila  among  patients  suspected of having TB. 
MATERIALS AND METHODS: This is a retrospective study done at the UST Hospital, a quality-assured referral center for TB in  Manila,  with  a  TB  Directly  Observed  Short  Course  (TB-DOTS) Clinic. Laboratory records of specimens submitted for  culture  and  sensitivity  studies  for  Mycobacterium tuberculosis  (MTB)  for  which  isolates  of  MOTT  grew,  using  BACTECTM(Becton-Dickinson)  method  and  Mycobacteria  Growth  Indicator  Tube  (MGITTM),  from  January  2003  to  December 2014, were reviewed.
RESULTS: A total of 6,886 specimens were submitted for MTB culture and sensitivity studies. Results showed 157 cases of MOTT with an incidence of 2.28%. Majority of the specimens with MOTT were from pulmonary sources (85%), most common of which was from sputum. Non pulmonary sources (15%) were mostly from urine, cerebro-spinal, and gastrointestinal tract. were isolated for MOTT. These find-ings are consistent with the previous local available data. Correct identification of this organism influence eventual decisions for treatment.
CONCLUSION: The incidence of positive culture for MOTT in our institution remains to be low. However, there is an increasing trend in the number of specimens which are turning out to be positive for MOTT. A future study on the correlation with the patients' clinical profile is recommended.

Human ; Mycobacterium Tuberculosis ; Sputum ; Tertiary Care Centers ; Philippines ; Tuberculosis, Pulmonary ; Tuberculosis ; Hiv Infections ; Gastrointestinal Tract

Gastrointestinal tuberculosis that is not an unusual form of extrapulmonary tuberculosis and it is usually associated with immunocompromised condition that may present with clinical symptoms including fever, weight loss or pain. Terminal ileum and cecum are the common sites of involvement, but involvement of the stomach is rare. Furthermore, synchronous tuberculosis involving both the stomach and lower gastrointestinal tract has been reported in very few cases. Herein, we report a case of incidentally detected synchronous tuberculosis involving both the stomach and terminal ileum that was successfully treated by antituberculosis therapy in an asymptomatic immunocompetent patient.
Adult ; Antitubercular Agents/therapeutic use ; Asymptomatic Infections ; Drug Therapy, Combination ; Endoscopy, Digestive System ; Female ; Humans ; Intestine, Small/pathology ; Stomach/pathology ; Tomography, X-Ray Computed ; Tuberculosis, Gastrointestinal/*diagnosis/drug therapy