Differentiating Intestinal Tuberculosis from Crohn’s Disease

Differentiating Crohn’s disease from intestinal tuberculosis is a diagnostic dilemma, particularly in regions where gastrointestinal tuberculosis is prevalent and Crohn’s disease incidence is increasing. Both of these granulomatous diseases present quite similarly, and diagnostic tests to identify Mycobacterium tuberculosis in tissue samples have rather poor sensitivity. Studies that were conducted to determine the factors that differentiate Crohn’s disease from intestinal tuberculosis identified some significant characteristics including clinical, endoscopy, pathology, imaging, and serology, but none of these characteristics are exclusive. Many diagnostic models or scoring systems that use one to several diagnostic parameters have been proposed to help distinguish these two intestinal diseases; however, they are required to be validated in further studies. Anti-tuberculous therapy is useful in differentiating these two diseases, and early mucosal response (endoscopic mucosal healing at 2 months) is needed to confirm the diagnosis of intestinal tuberculosis. However, anti-tubercular therapy may delay diagnosis of Crohn’s disease and can cause drug side effects. Future research is needed to better diagnose these two conditions.