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Open Access 01-12-2023 | Tuberculosis | Research

Frequency, outcomes, and need for intervention in stricturing gastrointestinal tuberculosis: a systematic review and meta-analysis

Authors: Anuraag Jena, Ritin Mohindra, Kirtan Rana, Pardhu B. Neelam, Dhuni Chand Thakur, Harjeet Singh, Pankaj Gupta, Vikas Suri, Vishal Sharma

Published in: BMC Gastroenterology | Issue 1/2023

Abstract

Background

Gastrointestinal strictures impact clinical presentation in abdominal tuberculosis and are associated with significant morbidity.

Aim

To conduct a systematic review of the prevalence of stricturing disease in abdominal and gastrointestinal tuberculosis and response to antitubercular therapy (ATT).

Methods

We searched Pubmed and Embase on 13th January 2022, for papers reporting on the frequency and outcomes of stricturing gastrointestinal tuberculosis. The data were extracted, and pooled prevalence of stricturing disease was estimated in abdominal tuberculosis and gastrointestinal (intestinal) tuberculosis. The pooled clinical response and stricture resolution (endoscopic or radiologic) rates were also estimated. Publication bias was assessed using the Funnel plot and Egger test. The risk of bias assessment was done using a modified Newcastle Ottawa Scale.

Results

Thirty-three studies reporting about 1969 patients were included. The pooled prevalence of intestinal strictures in abdominal tuberculosis and gastrointestinal TB was 0.12 (95%CI 0.07–0.20, I² = 89%) and 0.27 (95% CI 0.21–0.33, I² = 85%), respectively. The pooled clinical response of stricturing gastrointestinal tuberculosis to antitubercular therapy was 0.77 (95%CI 0.65–0.86, I² = 74%). The pooled stricture response rate (endoscopic or radiological) was 0.66 (95%CI 0.40–0.85, I² = 91%). The pooled rate of need for surgical intervention was 0.21 (95%CI 0.13–0.32, I² = 70%), while endoscopic dilatation was 0.14 (95%CI 0.09–0.21, I² = 0%).

Conclusion

Stricturing gastrointestinal tuberculosis occurs in around a quarter of patients with gastrointestinal tuberculosis, and around two-thirds of patients have a clinical response with antitubercular therapy. A subset of patients may need endoscopic or surgical intervention. The estimates for the pooled prevalence of stricturing disease and response to ATT had significant heterogeneity.

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Sharma V, Debi U, Mandavdhare HS, Prasad KK. Tuberculosis and other mycobacterial infections of the abdomen. In: Kuipers EJ. Encyclopedia of gastroenterology (Second Edition). Academic Press 2020; Pp 646–659

Sharma MP, Bhatia V. Abdominal tuberculosis. Indian J Med Res. 2004;120(4):305–15 ([PMID: 15520484]).PubMed

Rathi P, Gambhire P. Abdominal tuberculosis. J Assoc Physicians India. 2016;64(2):38–47 ([PMID: 27730779]).PubMed

Al-Zanbagi AB, Shariff MK. Gastrointestinal tuberculosis: a systematic review of epidemiology, presentation, diagnosis and treatment. Saudi J Gastroenterol: Off J Saudi Gastroenterol Assoc. 2021;27(5):261.

Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–12. https://doi.org/10.1001/jama.283.15.2008.CrossRefPubMed

Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:2700. https://doi.org/10.1136/bmj.b2700.CrossRef

Balduzzi S, Rücker G, Schwarzer G. How to perform a meta-analysis with R: a practical tutorial. Evid Based Ment Health. 2019;22(4):153–60. https://doi.org/10.1136/ebmental-2019-300117.CrossRefPubMed

Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Soft. 2022;36(3):1–48.

Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5. https://doi.org/10.1007/s10654-010-9491-z.CrossRefPubMed

10.

Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34. https://doi.org/10.1136/bmj.315.7109.629.CrossRefPubMedPubMedCentral

11.

Anand BS, Nanda R, Sachdev GK. Response of tuberculous stricture to antituberculous treatment. Gut. 1988;29(1):62–9. https://doi.org/10.1136/gut.29.1.62.CrossRefPubMedPubMedCentral

12.

Alvares JF, Devarbhavi H, Makhija P, Rao S, Kottoor R. Clinical, colonoscopic, and histological profile of colonic tuberculosis in a tertiary hospital. Endoscopy. 2005;37(4):351–6. https://doi.org/10.1055/s-2005-861116].CrossRefPubMed

13.

Aggarwal P, Kedia S, Sharma R, et al. Tubercular intestinal strictures show a poor response to anti-tuberculous therapy. Dig Dis Sci. 2017;62(10):2847–56. https://doi.org/10.1007/s10620-017-4727-3.CrossRefPubMed

14.

Amarapurkar DN, Patel ND, Rane PS. Diagnosis of Crohn’s disease in India where tuberculosis is widely prevalent. World J Gastroenterol. 2008;14(5):741–6. https://doi.org/10.3748/wjg.14.741.CrossRefPubMedPubMedCentral

15.

Bhargava DK, Kushwaha AK, Dasarathy S, Chopra P. Endoscopic diagnosis of segmental colonic tuberculosis. Gastrointest Endosc. 1992;38(5):571–4. https://doi.org/10.1016/s0016-5107(92)70519-7.CrossRefPubMed

16.

Cheng W, Zhang S, Li Y, Wang J, Li J. Intestinal tuberculosis: clinico-pathological profile and the importance of a high degree of suspicion. Trop Med Int Health. 2019;24(1):81–90. https://doi.org/10.1111/tmi.13169.CrossRefPubMed

17.

Das HS, Rathi P, Sawant P, et al. Colonic tuberculosis: colonoscopic appearance and clinico-pathologic analysis. J Assoc Physicians India. 2000;48(7):708–10 ([PMID:11273506]).PubMed

18.

Deka UJ, Dasgupta JK, Sarkar R, Das K, Banerjee S, Ahmed M, Bhattacharyya A, Basu K. A clinical study of intestinal tuberculosis with special reference to colonic involvement and response to short course anti-tuberculosis therapy. Indian Society of Gastroenterology. Indian J Gastroenterol. 2012; 31:1–114. https://doi.org/10.1007/s12664-012-0264-3

19.

Dutta AK, Sahu MK, Gangadharan SK, Chacko A. Distinguishing Crohn’s disease from intestinal tuberculosis–a prospective study. Trop Gastroenterol. 2011;32(3):204–9 ([PMID: 22332336]).PubMed

20.

Fillion A, Ortega-Deballon P, Al-Samman S, et al. Abdominal tuberculosis in a low prevalence country. Med Mal Infect. 2016;46(3):140–5. https://doi.org/10.1016/j.medmal.2016.02.003. (PMID: 26995289).CrossRefPubMed

21.

Gan H, Mely M, Zhao J, Zhu L. An analysis of the clinical, endoscopic, and pathologic features of intestinal tuberculosis. J Clin Gastroenterol. 2016;50(6):470–5. https://doi.org/10.1097/MCG.0000000000000514. (PMID: 26974755).CrossRefPubMed

22.

Hu ML, Lee CH, Kuo CM, et al. Abdominal tuberculosis: analysis of clinical features and outcome of adult patients in southern Taiwan. Chang Gung Med J. 2009;32(5):509–16 ([PMID: 19840508]).PubMed

23.

Jung Y, Hwangbo Y, Yoon SM, et al. Predictive factors for differentiating between Crohn’s disease and intestinal tuberculosis in Koreans. Am J Gastroenterol. 2016;111(8):1156–64. https://doi.org/10.1038/ajg.2016.212. (PMID: 27296940).CrossRefPubMed

24.

Kentley J, Ooi JL, Potter J, et al. Intestinal tuberculosis: a diagnostic challenge. Trop Med Int Health. 2017;22(8):994–9. https://doi.org/10.1111/tmi.12908. (PMID: 28609809).CrossRefPubMed

25.

Khan R, Abid S, Jafri W, Abbas Z, Hameed K, Ahmad Z. Diagnostic dilemma of abdominal tuberculosis in non-HIV patients: an ongoing challenge for physicians. World J Gastroenterol. 2006;12(39):6371–5. https://doi.org/10.3748/wjg.v12.i39.6371. (PMID: 17072964).CrossRefPubMedPubMedCentral

26.

Kim KM, Lee A, Choi KY, Lee KY, Kwak JJ. Intestinal tuberculosis: clinicopathologic analysis and diagnosis by endoscopic biopsy. Am J Gastroenterol. 1998;93(4):606–9. https://doi.org/10.1111/j.1572-0241.1998.173_b.x. (PMID: 9576456).CrossRefPubMed

27.

Larsson G, Shenoy KT, Ramasubramanian R, et al. High faecal calprotectin levels in intestinal tuberculosis are associated with granulomas in intestinal biopsies. Infect Dis (Lond). 2015;47(3):137–43. https://doi.org/10.3109/00365548.2014.974206. (PMID: 25522183).CrossRefPubMed

28.

Lee YJ, Yang SK, Byeon JS, et al. Analysis of colonoscopic findings in the differential diagnosis between intestinal tuberculosis and Crohn’s disease. Endoscopy. 2006;38(6):592–7. https://doi.org/10.1055/s-2006-924996. (PMID: 16673312).CrossRefPubMed

29.

Lu S, Fu J, Guo Y, Huang J. Clinical diagnosis and endoscopic analysis of 10 cases of intestinal tuberculosis. Medicine (Baltimore). 2020;99(28):e21175. https://doi.org/10.1097/MD.0000000000021175. (PMID: 32664157).CrossRefPubMed

30.

Lu Y, Chen Y, Peng X, et al. Development and validation of a new algorithm model for differential diagnosis between Crohn’s disease and intestinal tuberculosis: a combination of laboratory, imaging and endoscopic characteristics. BMC Gastroenterol. 2021;21(1):291. https://doi.org/10.1186/s12876-021-01838-x. (PMID: 34256708).CrossRefPubMedPubMedCentral

31.

Makanjuola D, al Orainy I, al Rashid R, Murshid K. Radiological evaluation of complications of intestinal tuberculosis. Eur J Radiol. 1998;26(3):261–268. https://doi.org/10.1016/s0720-048x(96)01091-1PMID: 9587753

32.

Millar AJW, Rode H, Cywes S. Abdominal tuberculosis in children surgical management. Pediatr SurgInt. 1990;5:392–6.

33.

Misra SP, Misra V, Dwivedi M, Gupta SC. Colonic tuberculosis: clinical features, endoscopic appearance and management. J Gastroenterol Hepatol. 1999;14(7):723–9. https://doi.org/10.1046/j.1440-1746.1999.01940.x. (PMID: 10440219).CrossRefPubMed

34.

Mukewar S, Mukewar S, Ravi R, Prasad A, S Dua K. Colon tuberculosis: endoscopic features and prospective endoscopic follow-up after anti-tuberculosis treatment. Clin Transl Gastroenterol. 2012;3(10):e24. https://doi.org/10.1038/ctg.2012.19PMID: 23238066

35.

Nagi B, Kochhar R, Bhasin DK, Singh K. Colorectal tuberculosis. Eur Radiol. 2003;13(8):1907–12. https://doi.org/10.1007/s00330-002-1409-z. (PMID: 12942293).CrossRefPubMed

36.

Palmer KR, Patil DH, Basran GS, Riordan JF, Silk DB. Abdominal tuberculosis in urban Britain–a common disease. Gut. 1985;26(12):1296–305. https://doi.org/10.1136/gut.26.12.1296. (PMID: 4085907).CrossRefPubMedPubMedCentral

37.

Singh H, Krishnamurthy G, Rajendran J, et al. Surgery for abdominal tuberculosis in the present Era: experience from a tertiary-care center. Surg Infect (Larchmt). 2018;19(6):640–5. https://doi.org/10.1089/sur.2018.077. (PMID: 30044168).CrossRefPubMed

38.

Singh V, Kumar P, Kamal J, Prakash V, Vaiphei K, Singh K. Clinicocolonoscopic profile of colonic tuberculosis. Am J Gastroenterol. 1996;91(3):565–8 ([PMID: 8633510]).PubMed

39.

Sinha S, Malik S, Kochhar R, Vaiphei K, Sharma K, Koshy A, Berry N, Dhaka N. Narrow band imaging guided biopsy improves yield of histology for diagnosis of gastrointestinal tuberculosis. Gastroenterology. 2017;152(5):S428–9. https://doi.org/10.1016/S0016-5085(17)31651-7.CrossRef

40.

Tripathi PB, Amarapurkar AD. Morphological spectrum of gastrointestinal tuberculosis. Trop Gastroenterol. 2009;30(1):35–9 ([PMID: 19624086]).PubMed

41.

Udgirkar S, Jain S, Pawar S, Chandnani S, Contractor Q, Rathi P. Clinical profile, drug resistance pattern and treatment outcomes of abdominal tuberculosis patients in Western India. Arq Gastroenterol. 2019;56(2):178–83. https://doi.org/10.1590/S0004-2803.201900000-35. (PMID: 31460583).CrossRefPubMed

42.

Uygur-Bayramicli O, Dabak G, Dabak R. A clinical dilemma: abdominal tuberculosis. World J Gastroenterol. 2003;9(5):1098–101. https://doi.org/10.3748/wjg.v9.i5.1098. (PMID: 12717865).CrossRefPubMedPubMedCentral

43.

Zhu QQ, Zhu WR, Wu JT, Chen WX, Wang SA. Comparative study of intestinal tuberculosis and primary small intestinal lymphoma. World J Gastroenterol. 2014;20(15):4446–52. https://doi.org/10.3748/wjg.v20.i15.4446. (PMID:24764686).CrossRefPubMedPubMedCentral

44.

Sharma V, Singh H, Mandavdhare HS. Tubercular abdominal cocoon: systematic review of an uncommon form of tuberculosis. Surg Infect (Larchmt). 2017;18(6):736–41. https://doi.org/10.1089/sur.2017.110.CrossRefPubMed

45.

Ahamed ZR, Shah J, Agarwala R, Kumar-M P, Mandavdhare HS, Gupta P, Singh H, Sharma A, Dutta U, Sharma V. Controversies in classification of peritoneal tuberculosis and a proposal for clinico-radiological classification. Expert Rev Anti Infect Ther. 2019;17(8):547–55. https://doi.org/10.1080/14787210.2019.1642746. (Epub 2019 Jul 17 PMID: 31293195).CrossRef

46.

Dasgupta A, Singh N, Bhatia A. Abdominal tuberculosis: a histopathological study with special reference to intestinal perforation and mesenteric vasculopathy. J Lab Phys. 2009;1(2):56–61. https://doi.org/10.4103/0974-2727.59700. (PMID: 21938251).CrossRef

47.

Sharma V, Mandavdhare HS, Dutta U. Letter: mucosal response in discriminating intestinal tuberculosis from Crohn’s disease-when to look for it? Aliment Pharmacol Ther. 2018;47(6):859–60.CrossRefPubMed

48.

Tandon HD, Prakash A. Pathology of intestinal tuberculosis and its distinction from Crohn’s disease. Gut. 1972;13(4):260–9.CrossRefPubMedPubMedCentral

49.

Rimola J, Capozzi N. Differentiation of fibrotic and inflammatory component of Crohn’s disease-associated strictures. Intest Res. 2020;18(2):144–50.CrossRefPubMedPubMedCentral

Title: Frequency, outcomes, and need for intervention in stricturing gastrointestinal tuberculosis: a systematic review and meta-analysis
Authors: Anuraag Jena
Ritin Mohindra
Kirtan Rana
Pardhu B. Neelam
Dhuni Chand Thakur
Harjeet Singh
Pankaj Gupta
Vikas Suri
Vishal Sharma
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Tuberculosis
Peritonitis
Tuberculosis
Published in: BMC Gastroenterology / Issue 1/2023
Electronic ISSN: 1471-230X
DOI: https://doi.org/10.1186/s12876-023-02682-x

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