A Study Of Clinical Differential Diagnosis Between Crohn's Disease And Intestinal Tuberculosis

Objective To investigate the Clinical Phenotype feature of Crohn's disease in China by applying Vienna and Montreal Classification.Methods The clinical data of 168 cases of inpatients with Crohn's disease in the Second Xiangya Hospital and the Xiangya Hospital were retrospectively analyzed and respectively classified according to Vienna and Montreal Classification to compare and analyze the characteristics of the subtype of Crohn's disease.Results According to Montreal Classification,9 patients of Al subtype with onset age less than or equal to 16 only took a proportion of 5.4%, while the proportion of cases with onset age focusing on 17-40 was 63.1%, in consistency with 65.5%, the proportion of subtype under 40 in line with Vienna Classification. Both with ileum and ileocolon subtype as the main involved location,7.1%, the proportion of L4 subtype under Montreal Classification, was obviously smaller than 13.7%, the proportion of L4 subtype under Vienna Classification (P=0.049).The proportion of stenosis subtype in disease behavior, as the main complication, was 40.5% and 41.7% under Vienna and Montreal respectively. Penetration subtype under Montreal Classification took the proportion of 10.7%, which was obviously smaller than 18.5% under Vienna Classification (P=0.044) The operation rate of penetrating behavior under Montreal Classification was 88.9% and thus much higher than 54.8% under Vienna Classification (P=0.014).Conclusions In China, adolescents seldom got Crohn's disease and patients were mainly in the age group of 17-40, with main involved location of ileum and ileocolon subtype and stenosis as common complication, and the major cause for operation was penetration. Both Vienna and Montreal have their own advantage in classifying patients with Crohn's disease in China. Therefore, it would be more valuable to comprehensively apply Vienna and Montreal Classification in clinically classifying patients of Crohn's diease in China. Objective To investigate the Clinical manifestation phenotype features of Crohn's disease.Methods The clinical data of 43 cases of surgery patients with Crohn's disease (surgery group) and 125 cases of non-surgery patients (non-surgery group) were retrospectively analyzed and classified according to Montreal Classification to compare the characteristics of the subtypes. Results The surgery patients whose age were between 17 and 40 years old were mostly A2 subtype taking a proportion of 65.1%, while A3 subtype whose age over 40 were taking a proportion of 32.6%. The proportion of involved location Llsubtype, L2 subtype, L3 subtype, L4 subtype were 41.9%,25.6%,30.2%,2.3% respectively. Disease behavior B1 subtype,B2 subtype,B3 subtype of surgery patients took a proportion of 2.3%,60.5%,37.2% respectively, which had a statistically significant difference with B1 subtype taking a proportion of 63.2%, B2 subtype 35.2%, B3 subtype 1.6% of non-surgery patients (P=0.001,P=0.004,P=0.001). Conclusions Most surgery patients with Crohn's disease were A2 subtype whose ages were 17-40 years old, L1 subtype and L3 subtype were main involved location, and B2 stenosis subtype and B3 penetration subtype as a view of disease behavior, which were the main reason for operation. and these features were helpful in making the diagosis and treatment methods. Objective To explore the distinctive diagnosis features of Crohn's disease(CD) and intestinal tuberculosis (ITB) in clinical and endoscopic datas. Methods A retrospective study enrolled 168 Crohn's disease and 156 intestinal tuberculosis inpatients in Xiangya second hospital, Xiangya hospital of central south university, and affiliated hospital of Jishou university from 2003 to 2009, and people's clinical and endoscopic datas were analyzed for differential diagnosis. Results The hospitalized patients with CD increased yearly in recent 5 years, and the disease history of CD was longer than that of ITB(p <0.05).The incidence of colectomy was higher in CD than in ITB(p< 0.05). Diarrhea, hematochezia, perianal disease, extraintestinal manifes-tation, intestinal obstruction, occurred significantly more in CD than in ITB (p<0.05 or p<0.01). night sweating, febrility, Pulmonary tuberculosis and ascites occurred significantly more in ITB than in CD (p<0.01). Hyperglobulin, increasederythrocyte sedimentation rate and the positive rate of serum antibody to mycobacterium were significantly higher in ITB than in CD (p<0.01).Longitudinal ulcer, grid-shape ulcer,cobblestone sign and intestinal stricture were discovered significantly more in CD than in ITB (p<0.05 or p<0.01), while transverse ulcer and involved ileocecal valve were found significantly more in ITB than in CD (p<0.01 and p<0.05), and deformed ileocecal valves had fixing bouche shape more in ITB than in CD (p<0.05).Conclusions There are certainly some differential characteristics between CD and ITB in clinical datas. Clinical characteristics, Longitudinal ulcer, grid-shape ulcer, transverse ulcer, cobblestone sign and the status of involved ileocecal valve play an important role to Differentiate Crohn's disease and intestinal tuberculosis. AIM:To investigate the values of clinical and endoscopic fingdings in differential diagnosis between Crohn's disease(CD) and intestinal tuberculosis(ITB).METHODS:Clinical and colonscopic data of 130 cases of inpatients with CD and 122 cases of inpatients with ITB from June 2003 to February 2009 were analyzed retrospetcively,and parameters were screened by logistic regression analysis. The diagnostic efficacy of screened parameters was analyzed by regression Equation (mathematical model) and Receiver Operating Characteristic curve (ROC curve).RESULTS:The clinical features helpful in differentiating CD from ITB are bloody stools (OR 4.09,95%CI:1.20-13.95), history of intestinal surgery (OR 16.42,95%CI: 3.19-84.56), perianal diseases (OR 15.07,95%CI:1.90-119.52), history of pulmonary tuberculosis (OR 113.10,95%CI:10.00-1279.30), ascites (OR 7.90,95%CI: 2.72-22.94) and postive of PPD skin test (OR 11.18,95%CI:3.74-33.41); The sensitivity, specificity, accuracy, positive predictive value and negetive predictive value of regression mathematical model established by clinical features were 90.3%, 76.8%,83.8%,80.7% and 88.0%, respectively. The endoscopic features helpful in differentiating CD from ITB were retcum involved (OR 4.48,95%CI:1.70-11.81), longitudinal ulcer (OR 5.78,95%CI:2.29=14.58), cobble pavement (OR 16.24, 95%CI:2.64-99.77), fixed open of ileocecal valve involved (OR 4.19,95%CI: 1.91-9.17), ring ulcer (OR 10.80,95%CI:3.47-33.62) and rodent ulcer (OR 28.31, 95%CI:2.38-337.19); The sensitivity, specificity, accurac, positive predictive value and negetive predictive value of regression mathematical model established by endoscopic features were 82.9%,82.0%,82.5%,82.9% and 82.0%, respectively.CONCLUSION:Screened parameters may aid in distinguishing between CD and ITB,and the sensitivity and accuracy for diagnosis can be increased by regression mathematical model established by clinical and endoscopic features, which is of high clinical significance and value. Objective:To get the information of diagnosis,treatment and prognosis of the post-discharged patients diagnosed Crohn disease and intestinal tuberculosis and to validate the appication value of the mathematics diagnosis equation in the clinical work. Methods:50 CD and 50 ITB cases were randomly selected from CD and ITB database, including 130 CD cases and 122 ITB cases. The detailed material such as the further treatment and its prognosis were obtained through telephone follow-ups. Diagnosis was obtained through clinical and endoscopy mathematics diagnosis equations and was compared with the result of the follow-ups to validate the diagnostic efficacy of the equations. Results:34 ITB cases were followed up and 31 were definite diagnosed. The average followed up duration was 28.77±10.53 months.32 CD cases were followed up and 32 were definite diagnosed. The average followed up duration was 29.56±14.90 months. ITB patients had a good drug compliance. The average drug-administration duration was 13.77±7.06 months. 29 cases were cured and 32 cases relatpsed. No drug-induced liver injury occurred or postdischarge operated cases. But the follow-up compliance was bad and drug taking was irregular.CD patients took 5-ASA mostly and drug administration compliance was poor. The average drug-administration duration was 15.31±11.12 months.9 cases (28.1%) were in steady remission status.16 cases were mend (50.0%).7 cases were deteriorated(21.9%).23 cases were relapsed after discharged (71.9%).3 cases were operated after discharged (9.4%).In 13 CD surgical patients, 6 were in steady remission status.5 cases were mend.2 cases were deteriorated. The general effect was better than non-operative patients. The coincidence of P value diagnosis and final diagnosis based on follow-ups is from 74.2 to 83.9%. The sensitivity, specificity and accuracy of the clinical mathematics diagnosis equations was 75.0%,74.2% and 74.6%, respectively.Conclusions:The prognosis of intestinal tuberculosis was good and with a low recurrence.Patients should be instructed to take medicine according to treatment and follow up on time.While the prognosis of Crohn disease was bad and with a high recurrence. Patients should be advised to have regular follow-up after discharged to improve drug compliance. Surgical treatment was beneficial for some patients because it can obtain a short-time remission and stability, which may be associated with clinical phenotypes of the patients. AIM:To explore the distinctive diagnostic features of biopsy and operative specimens between Crohn's disease and intestinal tuberculosis.METHODS:A retrospective study was performed to analyze the pathological features of 110 biopsy specimens (55 from patients with Crohn's disease, and 55 from patients with intestinal tuberculosis) and 38 operative specimens(29 from patients with Crohn's disease, and 9 from patients with intestinal tuberculosis). The value of these pathological features in differential diagnosis of the two diseases was analyzed.RESULTS:Positive rate of acid-fast stain in CD and intestinal tuberculosis groups were 1.2%,17.2% respectively, there was significant difference in the two groups(P<0.01).Pathologic parameters of biopsy specimens helpful in differentiating Crohn's disease from intestinal tuberculosis included broadened submucosa, fissure-like ulcer, and granuloma (37.5% vs 14.0%,10.9% vs 0%, and 10.9% vs 43.6%, respectively; all P<0.05). Pathologic parameters of operative specimens helpful in differentiating Crohn's disease from intestinal tuberculosis included broadened submucosa, fissure-like ulcer, broadened muscularis propria, cobblestone appearance, and granuloma (51.7%vs 11.1%,34.5% vs 0%,62.1% vs 11.1%,37.9% vs 0%, and 20.7% vs 77.8%, respectively; all P< 0.05).CONCLUSION:The pathological features of biopsy specimens have limited value in differential diagnosis of Crohn's disease and intestinal tuberculosis. The pathological features of operative specimens have appreciable value in differentiating Crohn's disease from intestinal tuberculosis. It is essential to combine clinical,endoscopic and imageologic parameters to differentially diagnose the two diseases. Aim:The research compared the characteristics and differences of intestinal flora between Crohn's disease and intestinal tuberculosis in order to find identification features of these two diseases.Methods:We choose 15 patients diagnosed as Crohn's disease and 23 patients diagnosed as intestinal tuberculosis during June 2007 and November 2009 in the Second XiangYa Hospital, XiangYa Hospital and central hospital of Changsha. Also 21 healthy people were included as control. Selective culture mediums were used for count the amount of bacteria.Results:The intestinal flora were mainly composed with bifidobacteria, bacteroid, escherichia coli and staphylococcus aureus both in Crohn's disease and intestinal tuberculosis. Lactobacillus and bifidobacteria decreased obviously but bacteroid increased in Crohn's disease compared with normal control group. Lactobacillus, bifidobacteria and escherichia coli decreased obviously but bacteroid increased in intestinal tuberculosis compared with normal control group. Bacteroid increased in intestinal tuberculosis compared with Crohn's disease. Enterococcus, staphylococcus aureus and saccharomycete were found no difference among groups.Conclusions:Intestinal flora disorder could be found in patients with Crohn's disease and intestinal tuberculosis. The alteration of bacteroid and escherichia coli could help to identify the two diseases. Supplement of probiotics may be adjuvant therapy for Crohn's disease and intestinal tuberculosis.