RT Journal Article
SR Electronic
T1 Endoscopic mucosal biopsies are useful in distinguishing granulomatous colitis due to Crohn’s disease from tuberculosis
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP 537
OP 541
DO 10.1136/gut.45.4.537
VO 45
IS 4
A1 A B Pulimood
A1 B S Ramakrishna
A1 G Kurian
A1 S Peter
A1 S Patra
A1 V I Mathan
A1 M M Mathan
YR 1999
UL http://gut.bmj.com/content/45/4/537.abstract
AB BACKGROUND Intestinal tuberculosis and Crohn’s disease are chronic granulomatous disorders that are difficult to differentiate histologically.AIMS To characterise distinctive diagnostic features of tuberculosis and Crohn’s disease in mucosal biopsy specimens obtained at colonoscopy.METHODS Selected 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.RESULTS The 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.CONCLUSIONS The 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.TECtuberculous ileocolitis