Predictors of Clinical and Endoscopic Findings in Differentiating Crohn's Disease from Intestinal Tuberculosis

Li, Xuefeng
Liu, Xiaowei
Zou, Yiyou
Ouyang, Chunhui
Wu, Xiaoping
Zhou, Minghuan
Chen, Linlin
Ye, Lingjuan
Lu, Fanggen

X. Li · X. Liu · C. Ouyang · X. Wu • L. Ye • F. Lu Division of Digestive Disease, 2nd Xiangya Hospital, Central South University, 410011 Changsha, Hunan, China e-mail: [email protected]
Y. Zou · L. Chen Division of Digestive Disease, Xiangya Hospital, Central South University, 410078 Changsha, Hunan, China
M. Zhou Division of Digestive Disease, The Affiliated Hospital of University of Jishou, 416000 Jishou, Hunan, China

Received: 17 November 2009 / Accepted: 25 March 2010 / Published online: 14 May 2010

Xuefeng Li and Xiaowei Liu contributed equally to this paper.

Digestive Diseases & Sciences 56(1):p 188-196, January 2011. | DOI: 10.1007/s10620-010-1231-4

Abstract

Background

There are many similarities and overlaps in clinical manifestations and ileocolonoscopic features between Crohn's disease (CD) and intestinal tuberculosis (ITB). Differentiation between CD and ITB is of great importance.

Aim

To investigate the values of clinical and endoscopic findings in differential diagnosis between CD and ITB.

Methods

Clinical and endoscopic features of a cohort of 130 cases of CD and 122 cases of ITB from June 2003 to February 2009 were retrospectively reviewed following predetermined criteria. Parameters were screened by logistic regression analysis. Furthermore, the diagnostic efficacy of screened parameters was analyzed by regression equation (mathematical model) and receiver operating characteristic curve (ROC curve).

Results

The clinical features helpful in differentiating CD from ITB are hematochezia, intestinal surgery, perianal diseases, pulmonary tuberculosis, ascites, and positive of PPD skin test; the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of regression mathematical model established by clinical features were 90.3, 76.8, 83.8, 80.7, and 88.0%, respectively. The endoscopic features helpful in differentiating CD from ITB were rectum involved lesions, longitudinal ulcer, cobblestone appearance, fixed-open ileocecal valve, transverse ulcer, and rodent ulcer; the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of regression mathematical model established by endoscopic features were 82.9, 82.0, 82.5, 82.9, and 82.0%, respectively.

Conclusions

It was proposed that a diagnostic algorithm based on available clinical and endoscopic regression equation could improve the current sensitivity, specificity, and accuracy in differentiating between CD from ITB.