Article
Endoscopic mucosal biopsies are useful in distinguishing
granulomatous colitis due to Crohn's disease from
tuberculosis
A B Pulimood, B S Ramakrishna, G Kurian, S Peter, S Patra, V I Mathan, M M Mathan
Wellcome Research
Unit, Department of Gastrointestinal Sciences, Christian Medical
College and Hospital, Vellore 632 004, Tamilnadu, India
Correspondence to: Dr A B Pulimood, Department of Surgery, School of Surgical Sciences, Medical School, University of Newcastle, Newcastle-upon-Tyne NE2 4HH, UK.
Accepted for publication 14 April 1999
BACKGROUND
Intestinal tuberculosis
and Crohn's disease are chronic granulomatous disorders that are
difficult to differentiate histologically.
AIMSTo characterise distinctive
diagnostic features of tuberculosis and Crohn's disease in mucosal
biopsy specimens obtained at colonoscopy.
METHODSSelected histological
parameters were evaluated retrospectively in a total of 61 biopsy
sites from 20 patients with tuberculosis and 112 biopsy sites from 20 patients with Crohn's disease. The patients were chosen on the basis
of clinical history, colonoscopic findings, diagnostic histology, and
response to treatment.
RESULTSThe histological parameters
characteristic of tuberculosis were multiple (mean number of granulomas
per section: 5.35), large (mean widest diameter: 193 µm), confluent
granulomas often with caseating necrosis. Other features were ulcers
lined by conglomerate epithelioid histiocytes and disproportionate
submucosal inflammation. The features characteristic of Crohn's
disease were infrequent (mean number of granulomas per section: 0.75),
small (mean widest diameter: 95 µm) granulomas, microgranulomas
(defined as poorly organised collections of epithelioid histiocytes),
focally enhanced colitis, and a high prevalence of chronic
inflammation, even in endoscopically normal appearing areas.
CONCLUSIONSThe type and frequency
of granulomas, presence or absence of ulcers lined by epithelioid
histiocytes and microgranulomas, and the distribution of chronic
inflammation have been identified as histological parameters that can
be used to differentiate tuberculosis and Crohn's disease in mucosal
biopsy specimens obtained at colonoscopy.
Keywords: tuberculosis; Crohn's disease; mucosal biopsy; histology
© 1999 by Gut
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