Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2015; 21(12): 3650-3656
Published online Mar 28, 2015. doi: 10.3748/wjg.v21.i12.3650
Differences in clinical features of Crohn's disease and intestinal tuberculosis
Xin Huang, Wang-Di Liao, Chen Yu, Yi Tu, Xiao-Lin Pan, You-Xiang Chen, Nong-Hua Lv, Xuan Zhu
Xin Huang, Wang-Di Liao, Xiao-Lin Pan, You-Xiang Chen, Nong-Hua Lv, Xuan Zhu, Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Chen Yu, Department of Radiology, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Yi Tu, Department of Pathology, First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Huang X and Liao WD equally contributed to this work; all authors performed the research; Huang X and Zhu X analyzed the data and wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xuan Zhu, Professor, Department of Gastroenterology, First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Zhen Street, Nanchang 330006, Jiangxi Province, China. zx15070877810@163.com
Telephone: +86-791-8692505 Fax: +86-791-8623153
Received: June 10, 2014
Peer-review started: June 11, 2014
First decision: June 27, 2014
Revised: September 8, 2014
Accepted: January 30, 2015
Article in press: January 30, 2015
Published online: March 28, 2015
Abstract

AIM: To investigate the clinical features of Crohn’s disease (CD) and intestinal tuberculosis (ITB) with a scoring system that we have developed.

METHODS: A total of 25 CD and 40 ITB patients were prospectively enrolled from August 2011 to July 2012. Their characteristics and clinical features were recorded. Laboratory, endoscopic, histologic and radiographic features were determined. The features with a high specificity were selected to establish a scoring system. The features supporting CD scored +1, and those supporting ITB scored -1; each patient received a final total score. A receiver operating characteristic (ROC) curve was used to determine the best cut-off value for distinguishing CD from ITB.

RESULTS: Based on a high specificity of differentiating between CD and ITB, 12 features, including longitudinal ulcers, nodular hyperplasia, cobblestone-like mucosa, intestinal diseases, intestinal fistula, the target sign, the comb sign, night sweats, the purified protein derivative test, the interferon-γ release assay (T-SPOT.TB), ring ulcers and ulcer scars, were selected for the scoring system. The results showed that the average total score of the CD group was 3.12 ± 1.740, the average total score of the ITB group was -2.58 ± 0.984, the best cutoff value for the ROC curve was -0.5, and the diagnostic area under the curve was 0.997, which was statistically significant (P < 0.001). The patients whose total scores were higher than -0.5 were diagnosed with CD; otherwise, patients were diagnosed with ITB. Overall, the diagnostic accuracy rate and misdiagnosis rate of this scoring system were 97% and 3%, respectively.

CONCLUSION: Some clinical features are valuable for CD and ITB diagnosis. The described scoring system is key to differentiating between CD and ITB.

Keywords: Crohn’s disease, Intestinal tuberculosis, Clinical features, Differential diagnosis, Scoring system

Core tip: Using various traditional diagnostic methods and currently emerging techniques, such as computed tomography enterography, this large-sample, prospective study identified specific indicators for differential diagnoses of Crohn’s disease and intestinal tuberculosis and used these indicators to establish a highly valuable scoring system for differential diagnosis.