Identification of parameters that help in differentiating Crohn's disease from intestinal tuberculosis.

INTRODUCTION : Crohn’s disease (CD) and intestinal tuberculosis (ITB) are chronic diseases of the intestine. These diseases can present with similar clinical, radiologic, endoscopic and histopathologic findings. Hence differentiating these diseases from one another can be difficult. This affects the treatment. In event of misdiagnosis, treating Crohn’s disease with anti tubercular drugs can result in the patient being exposed to the toxicity of these drugs as well as delay in treatment of Crohn’s disease. On the other hand, treating a tuberculosis patient misdiagnosed as Crohn’s disease with steroids can result in flare up or dissemination of tuberculosis which can be disastrous. These issues emphasize the need for a definite diagnosis before the start of therapy. There are a few reports which suggest that differentiation of Crohn’s disease from intestinal tuberculosis is possible on the basis of endoscopic and histological characteristics. Individual investigation results ( except presence of AFB or caseating granulomas for tuberculosis ) are often found insufficient for diagnosis. There is therefore a need for a comprehensive study that can effectively differentiate intestinal tuberculosis from Crohn’s disease. AIMS : 1) To analyze clinical, laboratory, radiologic, endoscopic and histological characteristics of intestinal tuberculosis and Crohn’s disease and identify the parameters that differentiate the two diseases. and 2) To devise and validate a scoring system to help differentiate Crohn’s disease from intestinal tuberculosis. CONCLUSION : Evaluation of clinical, radiological, colonoscopic and histological parmeters were performed to differentiate intestinal tuberculosis from Crohn’s disease. 1) On univariate analysis - *Parameters favouring intestinal tuberculosis were -