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Use of steroids for abdominal tuberculosis: a systematic review and meta-analysis

Abstract

Background

The role of adjunctive steroids in abdominal tuberculosis is unclear.

Objective

To evaluate effect of adjunctive use of steroids for abdominal tuberculosis in reducing/preventing complications.

Methods

We searched electronic databases (Medline, Embase, CENTRAL, Scopus, Web of Science, CINAHL) from inception to 25th June 2018 using the terms “abdominal tuberculosis” OR “intestinal tuberculosis” OR “peritoneal tuberculosis” OR “tuberculous peritonitis” AND steroids OR methylprednisolone OR prednisolone. Bibliography of potential articles was also searched. We included studies comparing adjunctive steroids to antitubercular therapy (ATT) alone. We excluded non-English articles, case reports, reviews and unrelated papers. The primary outcome was a comprehensive clinical outcome including need for surgery or the presence of symptomatic stricture (abdominal pain or intestinal obstruction). Quality assessment of included studies was done using ROBINS-I tool. Random-effects model was used to calculate the summary effect for all the outcomes.

Results

Of total 633 records, three studies on peritoneal tuberculosis were included in meta-analysis. These papers were of poor quality (one quasi-randomised study and two retrospective cohort studies). Meta-analyses showed adjunctive steroids, with ATT is more effective than ATT alone in tuberculous peritonitis patients for the prevention of composite end point (RR 0.15 [0.04, 0.62], p = 0.008), symptomatic stricture(RR 0.15 [0.04–0.62] p = 0.008) and intestinal obstruction (RR 0.18 [0.03–0.99] p = 0.05).

Conclusion

The data on use of steroids for abdominal tuberculosis are limited to peritoneal tuberculosis. Although steroids seem to have some benefit in patients of tubercular peritonitis, the poor quality of studies limits the generalisability of the findings.

Systematic review registration number

CRD42016047347.

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References

  1. 1.

    Sharma V, Debi U, Mandavdhare HS, Prasad KK. Abdominal tuberculosis and other mycobacterial infections. Ref Module Biomed Sci. 2018. https://doi.org/10.1016/B978-0-12-801238-3.65963-9.

    Article  Google Scholar 

  2. 2.

    Cherian JJ, Lobo I, Sukhlecha A, Chawan U, Kshirsagar NA, Nair BL, et al. Treatment outcome of extrapulmonary tuberculosis under Revised National Tuberculosis Control Programme. Indian J Tuberc. 2017;64:104–8.

    Article  CAS  PubMed  Google Scholar 

  3. 3.

    Norbis L, Alagna R, Tortoli E, Codecasa LR, Migliori GB, Cirillo DM. Challenges and perspectives in the diagnosis of extrapulmonary tuberculosis. Expert Rev Anti Infect Ther. 2014;12:633–47.

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Sharma MP, Bhatia V. Abdominal tuberculosis. Indian J Med Res. 2004;120:305–15.

    CAS  PubMed  Google Scholar 

  5. 5.

    Vaid U, Kane GC. Tuberculous peritonitis. Microbiol Spectr 2017. https://doi.org/10.1128/microbiolspec.TNMI7-0006-2016.

    Article  PubMed  Google Scholar 

  6. 6.

    Sanai FM, Bzeizi KI. Systematic review: tuberculous peritonitis—presenting features, diagnostic strategies and treatment. Aliment Pharmacol Ther. 2005;22:685–700.

    Article  CAS  PubMed  Google Scholar 

  7. 7.

    Sharma SK, Ryan H, Khaparde S, Sachdeva KS, Singh AD, Mohan A, et al. Index-TB guidelines: guidelines on extrapulmonary tuberculosis for India. Indian J Med Res. 2017;145:448–463.

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Singh H, Krishnamurthy G, Rajendran J, Sharma V, Mandavdhare H, Kumar H, et al. Surgery for abdominal tuberculosis in the present era: experience from a tertiary-care center. Surg Infect (Larchmt). 2018. https://doi.org/10.1089/sur.2018.077.

    Article  Google Scholar 

  9. 9.

    Pratap Mouli V, Munot K, Ananthakrishnan A, Kedia S, Addagalla S, Garg SK,et al. Endoscopic and clinical responses to antitubercular therapy can differentiate intestinal tuberculosis from Crohn’s disease. Aliment Pharmacol Ther. 2017;45:27–36.

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    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;47:859–860.

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Singh MM, Bhargava AN, Jain KP. Tuberculous peritonitis. An evaluation of pathogenetic mechanisms, diagnostic procedures and therapeutic measures. N Engl J Med. 1969;13:1091–4. 281(.

    Article  Google Scholar 

  14. 14.

    Alrajhi AA, Halim MA, al-Hokail A, Alrabiah F, al-Omran K. Corticosteroid treatment of peritoneal tuberculosis. Clin Infect Dis. 1998;27:52–6.

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    Demir K, Okten A, Kaymakoglu S, Dincer D, Besisik F, Cevikbas U, et al. Tuberculous peritonitis—reports of 26 cases, detailing diagnostic and therapeutic problems. Eur J Gastroenterol Hepatol. 2001;13:581–5.

    Article  CAS  PubMed  Google Scholar 

  16. 16.

    Bastani B, Shariatzadeh MR, Dehdashti F. Tuberculous peritonitis—report of 30 cases and review of the literature. Q J Med. 1985;56:549–57.

    CAS  PubMed  Google Scholar 

  17. 17.

    Veeragandham RS, Lynch FP, Canty TG, Collins DL, Danker WM. Abdominal tuberculosis in children: review of 26 cases. J Pediatr Surg. 1996;31:170–5.

    Article  CAS  PubMed  Google Scholar 

  18. 18.

    Poyrazoglu OK, Timurkaan M, Yalniz M, Ataseven H, Dogukan M, Bahcecioglu IH. Clinical review of 23 patients with tuberculous peritonitis: presenting features and diagnosis. J Dig Dis. 2008;9:170–4.

    Article  PubMed  Google Scholar 

  19. 19.

    Aggarwal P, Kedia S, Sharma R, Bopanna S, Madhusudhan KS, Yadav DP, Goyal S, Jain S, Mouli VP, Das P, Dattagupta S, Makharia G, Ahuja V. Tubercular intestinal strictures show a poor response to anti-tuberculous therapy. Dig Dis Sci. 2017;62:2847–56.

    Article  PubMed  Google Scholar 

  20. 20.

    Sharma V, Singh H, Mandavdhare HS. Tubercular abdominal cocoon: systematic review of an uncommon form of tuberculosis. Surg Infect (Larchmt). 2017;18:736–741.

    Article  PubMed  Google Scholar 

  21. 21.

    Prasad K, Singh MB, Ryan H. Corticosteroids for managing tuberculous meningitis. Cochrane Database Syst Rev. 2016;4:CD002244.

    PubMed  Google Scholar 

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Affiliations

Authors

Contributions

VS, HaS (Harjeet Singh): Conception. HS (Hariom Soni), BLB, VS: Literature search. HS, BLB, RRK, PMK, VS: Data extraction and risk of bias assessment. HS, BLB, RRK, PMK, VS: Data analysis. HS, BLB, VS: Initial draft. HSM, HaS, UD, VS: Important intellectual content and manuscript revision. HS, BLB: Equal contribution. All authors: final approval.

Corresponding author

Correspondence to Vishal Sharma.

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Soni, H., Bellam, B.L., Rao, R.K. et al. Use of steroids for abdominal tuberculosis: a systematic review and meta-analysis. Infection 47, 387–394 (2019). https://doi.org/10.1007/s15010-018-1235-0

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Keywords

  • Abdominal tuberculosis
  • Tuberculous peritonitis
  • Antitubercular therapy
  • Steroids
  • Stricture
  • Surgery