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World J Gastroenterol. Jan 28, 2011; 17(4): 433-443
Published online Jan 28, 2011. doi: 10.3748/wjg.v17.i4.433
Differentiation of Crohn’s disease from intestinal tuberculosis in India in 2010
Anna Benjamin Pulimood, Deepak Narayan Amarapurkar, Ujjala Ghoshal, Mathew Phillip, Cannanore Ganesh Pai, Duvvur Nageshwar Reddy, Birender Nagi, Balakrishna Siddhartha Ramakrishna
Anna Benjamin Pulimood, Department of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu 632004, India
Deepak Narayan Amarapurkar, Department of Gastroenterology, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra 400025, India
Ujjala Ghoshal, Department of Microbiology, Sanjay Gandhi Postgraduate Institute, Lucknow, Uttar Pradesh 226014, India
Mathew Phillip, PVS Institute of Digestive Diseases, PVS Hospital, Kochi, Kerala 682017, India
Cannanore Ganesh Pai, Department of Gastroenterology and Hepatology, Kasturba Medical College, Manipal, Karnataka 576104, India
Duvvur Nageshwar Reddy, Asian Institute of Gastroenterology, Hyderabad, Andhra Pradesh 500082, India
Birender Nagi, Department of Gastroenterology, Postgraduate Institute, Chandigarh 160012, India
Balakrishna Siddhartha Ramakrishna, Department of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu 632004, India
Author contributions: Pulimood AB coordinated this review and contributed the section on pathology; Amarapurkar DN contributed the sections on clinical features and PCR for Mycobacterium tuberculosis; Ghoshal U contributed the sections on serology and cultures; Phillip M contributed the sections on Quantiferon TB Gold and surgery; Pai CG contributed the section on endoscopy; Reddy DN contributed the section on capsule endoscopy and small bowel enteroscopy; Nagi B contributed the section on radiology; Ramakrishana BS contributed the section on the role of therapy.
Correspondence to: Dr. Anna Benjamin Pulimood, Department of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu 632004, India.
Telephone: +91-416-2282052 Fax: +91-416-2282486
Received: May 6, 2010
Revised: July 12, 2010
Accepted: July 19, 2010
Published online: January 28, 2011

Differentiating intestinal tuberculosis from Crohn’s disease (CD) is an important clinical challenge of considerable therapeutic significance. The problem is of greatest magnitude in countries where tuberculosis continues to be highly prevalent, and where the incidence of CD is increasing. The final clinical diagnosis is based on a combination of the clinical history with endoscopic studies, culture and polymerase chain reaction for Mycobacterium tuberculosis, biopsy pathology, radiological investigations and response to therapy. In a subset of patients, surgery is required and intraoperative findings with pathological study of the resected bowel provide a definitive diagnosis. Awareness of the parameters useful in distinguishing these two disorders in each of the different diagnostic modalities is crucial to accurate decision making. Newer techniques, such as capsule endoscopy, small bowel enteroscopy and immunological assays for Mycobacterium tuberculosis, have a role to play in the differentiation of intestinal tuberculosis and CD. This review presents currently available evidence regarding the usefulness and limitations of all these different modalities available for the evaluation of these two disorders.

Keywords: Tuberculosis, Crohn’s disease, Clinical features, Endoscopy, Serology, Enteroscopy, Histology, Radiology, Surgery, Therapy