Chapter 23 : Gastrointestinal Tuberculosis

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This chapter on gastrointestinal tuberculosis (TB) highlights that the colon and small bowel alone are the next most frequent sites of infection following the ileocecal region. The esophagus and stomach are rarely involved. Symptoms of gastrointestinal TB such as abdominal pain weight loss, fever nausea, vomiting, diarrhea and constipation are discussed in the chapter. The first primary case of esophageal TB was described in 1837 on an autopsy by Denonvilliers. The middle one-third of the esophagus is the most common location for tuberculous involvement. The diagnosis and various medical therapies for esophageal TB are discussed in the chapter. Surgery is usually required for gastric outlet obstruction, and the most common procedures described are gastrojejunostomy or antrectomy with Billroth II reconstruction. The importance in distinguishing ileal TB from Crohn’s disease is further highlighted because the treatment is vastly different. Colonic TB can involve any portion of the large bowel; however, the ileocecal region is the most common site of intestinal involvement, followed by the ascending colon. The diagnosis of intestinal TB should be considered in anyone with abdominal symptoms from an area where TB is endemic. PCR analyses of mucosal biopsy specimens from endoscopy have been shown to be a valuable tool in improving diagnostic yield with a high specificity of 95%. Radiographic imaging studies usually provide corollary information to prompt further investigation but rarely establish the diagnosis because of the nonspecific signs of intestinal TB.

Citation: Choi E, Coyle W. 2011. Gastrointestinal Tuberculosis, p 350-366. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch23
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Image of Figure 1.
Figure 1.

Endoscopic image of tuberculous involvement of the ileocecal valve and proximal colon. (Courtesy of Si Young Song, Kyung Joo Lee, and Moon Jae Chung.)

Citation: Choi E, Coyle W. 2011. Gastrointestinal Tuberculosis, p 350-366. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch23
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Image of Figure 2.
Figure 2.

Endoscopic image of a patulous ileocecal valve with a classic, fish mouth deformity and an ascending colon with mucosal erythema and nodularity secondary to TB. (Courtesy of Si Young Song, Kyung Joo Lee, and Moon Jae Chung.)

Citation: Choi E, Coyle W. 2011. Gastrointestinal Tuberculosis, p 350-366. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch23
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Image of Figure 3.
Figure 3.

Colonoscopic image of pseudopolyposis and stenosis from TB involvement of the transverse colon. (Courtesy of Si Young Song, Kyung Joo Lee, and Moon Jae Chung.)

Citation: Choi E, Coyle W. 2011. Gastrointestinal Tuberculosis, p 350-366. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch23
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Image of Figure 4.
Figure 4.

CT scan demonstrating segmental and circumferential wall thickening of the proximal colon due to TB involvement. (Courtesy of Si Young Song, Kyung Joo Lee, and Moon Jae Chung.)

Citation: Choi E, Coyle W. 2011. Gastrointestinal Tuberculosis, p 350-366. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch23
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Table 1.

Symptoms of gastrointestinal tuberculosis

Citation: Choi E, Coyle W. 2011. Gastrointestinal Tuberculosis, p 350-366. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch23

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