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Epidemiology of Gastrointestinal Tuberculosis

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Book cover Tuberculosis of the Gastrointestinal system

Abstract

Tuberculosis can involve any organ situated in the abdomen and gastrointestinal tuberculosis is a frequent site of involvement. Exact data on incidence and proportion of gastrointestinal tuberculosis but may account for around 10% of extra-pulmonary tuberculosis. Tuberculosis of the peritoneum followed by intestinal tuberculosis is the most common type of abdominal tuberculosis. While peritoneal tuberculosis is often considered the most frequent form of gastrointestinal tuberculosis, most reports from tertiary centers suggest a preponderance of intestinal tuberculosis. The two forms may coexist in around 10% of cases. Gastrointestinal tuberculosis also includes the less frequent variants like visceral tuberculosis (hepatobiliary system, pancreas, and spleen) and other luminal forms (gastro-duodenal, esophageal). The risk factors for abdominal tuberculosis are cirrhosis of the liver, HIV/AIDS, chronic kidney disease, diabetes mellitus, and malnutrition. This chapter reviews the epidemiological information about gastrointestinal tuberculosis of each intra-abdominal organ/system, including the magnitude of the burden, demographics, risk factors contributing to the disease, drug resistance, and finally the outcomes.

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References

  1. World Health Organization. Global tuberculosis report 2019. Available at https://apps.who.int/iris/bitstream/handle/10665/329368/9789241565714-eng.pdf?ua=1. Accessed 21 March 2020.

  2. Montales MT, Chaudhury A, Beebe A, Patil S, Patil N. HIV-associated TB syndemic: a growing clinical challenge. Front Public Health. 2015;3:281.

    PubMed  PubMed Central  Google Scholar 

  3. Guth AA, Kim U. The reappearance of abdominal tuberculosis. Surg Gynecol Obstet. 1991;172:432–6.

    CAS  PubMed  Google Scholar 

  4. Watson JM, Gill ON. HIV infection and tuberculosis. BMJ. 1990;300:63–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Rathi PM, Amarapurakar DN, Parikh SS, Joshi J, Koppikar GV, Amarapurkar AD, et al. Impact of human immunodeficiency virus infection on abdominal tuberculosis in western India. J Clin Gastroenterol. 1997;24:43–8.

    CAS  PubMed  Google Scholar 

  6. Sotgiu G, Migliori GB. Extra-pulmonary tuberculosis: the comorbidity of the near future? Int J Tuberc Lung Dis. 2014;18:1389.

    PubMed  Google Scholar 

  7. Peto HM, Pratt RH, Harrington TA, LoBue PA, Armstrong LR. Epidemiology of extrapulmonary tuberculosis in the United States, 1993–2006. Clin Infect Dis. 2009;49:1350–7.

    PubMed  Google Scholar 

  8. Gomes T, Reis-Santos B, Bertolde A, Johnson JL, Riley LW, Maciel EL. Epidemiology of extrapulmonary tuberculosis in Brazil: a hierarchical model. BMC Infect Dis. 2014;14:9.

    PubMed  PubMed Central  Google Scholar 

  9. Medical Research Council Tuberculosis and Chest Diseases Unit. National survery of tuberculosis notifications in England and Wales. BMJ. 1980;281:895–8.

    Google Scholar 

  10. Kang W, Yu J, Du J, Yang S, Chen H, Liu J, Ma J, Li M, Qin J, Shu W, Zong P. The epidemiology of extrapulmonary tuberculosis in China: a large-scale multi-center observational study. PLoS One. 2020;15:e0237753.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Sandgren A, Hollo V, Van Der Werf MJ. Extrapulmonary tuberculosis in the European Union and European economic area, 2002 to 2011. Eur Secur. 2013;18:20431.

    Google Scholar 

  12. García-Rodríguez JF, Álvarez-Díaz H, Lorenzo-García MV, Mariño-Callejo A, Fernández-Rial Á, Sesma-Sánchez P. Extrapulmonary tuberculosis: epidemiology and risk factors. Enfermedades infecciosas y microbiologia clinica. 2011;29:502–9.

    PubMed  Google Scholar 

  13. Prakasha SR, Suresh G, D’sa IP, Shetty SS, Kumar SG. Mapping the pattern and trends of extrapulmonary tuberculosis. J Global Infect Dis. 2013;5:54–9.

    Google Scholar 

  14. Cherian JJ, Lobo I, Sukhlecha A, Chawan U, Kshirsagar NA, Nair BL, Sawardekar L. Treatment outcome of extrapulmonary tuberculosis under Revised National Tuberculosis Control Programme. Indian J Tuberc. 2017 Apr;64(2):104–8.

    CAS  PubMed  Google Scholar 

  15. Marshall JB. Tuberculosis of the gastrointestinal tract and peritoneum. Am J Gastroenterol. 1993;88:989–99.

    CAS  PubMed  Google Scholar 

  16. Mehta JB, Dutt A, Harvill L, Mathews KM. Epidemiology of extrapulmnonary tuberculosis: a comparative analysis with pre-AIDS era. Chest. 1991;99:1134–8.

    CAS  PubMed  Google Scholar 

  17. Cho JK, Choi YM, Lee SS, Park HK, Cha RR, Kim WS, Kim JJ, Lee JM, Kim HJ, Ha CY, Kim HJ. Clinical features and outcomes of abdominal tuberculosis in southeastern Korea: 12 years of experience. BMC Infect Dis. 2018;18:699.

    PubMed  PubMed Central  Google Scholar 

  18. Chow KM, Chow VCY, Szeto CC. Indication for peritoneal biopsy in tuberculous peritonitis. Am J Surg. 2003;185:567–73.

    PubMed  Google Scholar 

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

    CAS  Google Scholar 

  20. Al Karawi MA, Mohamed AE, Yasawy MI, et al. Protean manifestations of gastrointestinal tuberculosis: report on 130 patients. J Clin Gastroenterol. 1995;20:225–32.

    PubMed  Google Scholar 

  21. Sheldon CD, Probert CS, Cock H, et al. Incidence of abdominal tuberculosis in Bangladeshi migrants in east London. Tuber Lung Dis. 1993;74:12–5.

    CAS  PubMed  Google Scholar 

  22. Radhika S, Rajwanshi A, Kochhar R, et al. Abdominal tuberculosis: diagnosis by fine needle aspiration cytology. Acta Cytol. 1993;37:73–8.

    Google Scholar 

  23. Aguado JM, Pons F, Casafont F, San Miguel G, Valle R. Tuberculous peritonitis: a study comparing cirrhotic and noncirrhotic patients. J Clin Gastroenterol. 1990;12:550–4.

    CAS  PubMed  Google Scholar 

  24. Shakil AO, Korula J, Kanel GC, et al. Diagnostic features of tuberculous peritonitis in the absence and presence of chronic liver disease: a case control study. Am J Med. 1996;100:179–85.

    CAS  PubMed  Google Scholar 

  25. Manohar A, Simjee AE, Haffejee AA, Pettengell KE. Symptoms and investigative findings in 145 patients with tuberculous peritonitis diagnosed by peritoneoscopy and biopsy over a five year period. Gut. 1990;31:1130–2.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Al Muneef M, Memish Z, Al Mahmoud S, et al. Tuberculosis in the belly: a review of forty-six cases involving the gastrointestinal tract and peritoneum. Scand J Gastroenterol. 2001;5:528–32.

    Google Scholar 

  27. Nagi B, Lal A, Kochhar R, Bhasin DK, Gulati M, Suri S, Singh K. Imaging of esophageal tuberculosis: a review of 23 cases. Acta Radiol. 2003;44:329–33.

    CAS  PubMed  Google Scholar 

  28. Mokoena T, Shama DM, Ngakane H, Bryer JV. Oesophageal tuberculosis: a review of eleven cases. Postgrad Med J. 1992;68:110–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Dow CJ. Oesophageal tuberculosis: four cases. Gut. 1981;22:234–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Nagi B, Lal A, Kochhar R, Bhasin DK, Gulati M, Suri S, Singh K. Imaging of esophageal tuberculosis: a review of 23 cases. Acta Radiol. 2003;44:329–33.

    CAS  PubMed  Google Scholar 

  31. Rao YG, Pande GK, Sahni P, Chattopadhyay TK. Gastroduodenal tuberculosis management guidelines, based on a large experience and a review of the literature. Can J Surg. 2004;47:364–8.

    PubMed  PubMed Central  Google Scholar 

  32. Subei I, Attar B, Schmitt G, Levendoglu H. Primary gastric tuberculosis: a case report and literature review. Am J Gastroenterol. 1987;82:769–72.

    CAS  PubMed  Google Scholar 

  33. Mitchell R, Bristol L. Intestinal tuberculosis: analysis of 346 cases diagnosed by routine intestinal radiography on 5529 admissions for pulmonary tuberculosis. Am J Med Sci. 1954;227:241–9.

    CAS  PubMed  Google Scholar 

  34. Ma J, Yin H, Xie H. Critical role of molecular test in early diagnosis of gastric tuberculosis: a rare case report and review of literature. BMC Infect Dis. 2019;19:589.

    PubMed  PubMed Central  Google Scholar 

  35. Rao YG, Pande GK, Sahni P, Chattopadhyay TK. Gastroduodenal tuberculosis management guidelines, based on a large experience and a review of the literature. Can J Surg. 2004;47:364–8.

    PubMed  PubMed Central  Google Scholar 

  36. Bhansali SK. Abdominal tuberculosis. Experiences with 300 cases. Am J Gastroenterol. 1977;67:324–37.

    CAS  PubMed  Google Scholar 

  37. Chavhan GE, Ramakantan R. Duodenal tuberculosis: radiological features on barium studies and their clinical correlation in 28 cases. J Postgrad Med. 2003;49:214–7.

    CAS  PubMed  Google Scholar 

  38. Farer LS, Lowell AM, Meador MP. Extrapulmonary tuberculosis in the United States. Am J Epidemiol. 1979;109:205–17.

    CAS  PubMed  Google Scholar 

  39. Munot K, Ananthakrishnan AN, Singla V, Benjamin J, Kedia S, Dhingra R, Makharia GK, Ahuja V. Response to trial of antitubercular therapy in patients with ulceroconstrictive intestinal disease and an eventual diagnosis of Crohn's disease. Gastroenterology. 2011;140:S-159.

    Google Scholar 

  40. Mukhopadhyay A, Dey R, Bhattacharya U. Abdominal tuberculosis with an acute abdomen: our clinical experience. J Clin Diagn Res. 2014;8:NC07–9.

    PubMed  PubMed Central  Google Scholar 

  41. Adhikari S, Hossein MZ, Das A, Mitra N, Ray U. Etiology and outcome of acute intestinal obstruction: a review of 367 patients in Eastern India. Saudi J Gastroenterol. 2010;16:285–7.

    PubMed  Google Scholar 

  42. Chalya PL, Mchembe MD, Mshana SE, Rambau P, Jaka H, Mabula JB. Tuberculous bowel obstruction at a university teaching hospital in Northwestern Tanzania: a surgical experience with 118 cases. World J Emerg Surg. 2013;8:12.

    PubMed  PubMed Central  Google Scholar 

  43. Tandon RK, Sarin SK, Bose SL, Berry M, Tandon BN. A clinico-radiological reappraisal of intestinal tuberculosis-changing profile? Gastroenterol Jpn. 1986;21:17–22.

    CAS  PubMed  Google Scholar 

  44. Dorairajan LN, Gupta S, Deo SV, Chumber S, Sharma L. Peritonitis in India – a decade’s experience. Trop Gastroenterol. 1995;16:33–8.

    CAS  PubMed  Google Scholar 

  45. Kapoor VK, Kriplani AK, Chattopadhyay TK, Sharma LK. Tuberculous perforations of the small intestine. Ind J Tub. 1986;33:188–9.

    Google Scholar 

  46. Talwar S, Talwar R, Prasad P. Tuberculous perforations of the small intestine. Int J Clin Pract. 1999;53:514–8.

    CAS  PubMed  Google Scholar 

  47. Anand AC, Patnaik PK, Bhalla VP, Chaudhary R, Saha A, Rana VS. Massive lower intestinal bleeding--a decade of experience. Trop Gastroenterol. 2001;22:131–4.

    CAS  PubMed  Google Scholar 

  48. Anand BS, Nanda R, Sachdev GK. Response of tuberculous stricture to antituberculous treatment. Gut. 1988;29:62–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Tishler JM. Tuberculosis of the transverse colon. Am J Roentgen. 1979;133:229–32.

    CAS  Google Scholar 

  50. Kochhar R, Sood A, Wig JD, Thapa BR, Gupta NM, Nagi B, et al. Spectrum of isolated colorectal tuberculosis. Indian J Gastroenterol. 1989;8:A56–7.

    Google Scholar 

  51. Shah S, Thomas V, Mathan M, Chacko A, Chandy G, Ramakrishna BS, Rolston DD. Colonoscopic study of 50 pa- tients with colonic tuberculosis. Gut. 1992;33:347–51.

    CAS  PubMed  PubMed Central  Google Scholar 

  52. Mukewar S, Mukewar S, Ravi R, Prasad A, Dua KS. Colon tuberculosis: endoscopic features and prospective endoscopic follow-up after anti-tuberculosis treatment. Clin Trans Gastroenterol. 2012;3:e24.

    Google Scholar 

  53. Tan TC, Cheung AY, Wan WY, et al. Tuberculoma of the liver presenting as a hyperechoic mass on ultrasound. Br J Radiol. 1997;70:1293–5.

    CAS  PubMed  Google Scholar 

  54. Yu RS, Zhang SZ, Wu JJ, et al. Imaging diagnosis of 12 patients with hepatic tuberculosis. World J Gastroenterol. 2004;10:1639–42.

    PubMed  PubMed Central  Google Scholar 

  55. Essop AR, Posen JA, Hodkinson JH, Segal I. Tuberculosis hepatitis: a clinical review of 96 cases. QJM. 1984;53:465–77.

    CAS  PubMed  Google Scholar 

  56. Tai WC, Kuo CM, Lee CH, Chuah SK, Huang CC, Hu TH, et al. Liver tuberculosis in Southern Taiwan: 15-years clinical experience. J Intern Med Taiwan. 2008;19:410–7.

    Google Scholar 

  57. Alvarez SZ, Carpio R. Hepatobiliary tuberculosis. Dig Dis Sci. 1983;28:193–200.

    CAS  PubMed  Google Scholar 

  58. Brauner M, Buffard MD, et al. Sonography and computed tomography of macroscopic tuberculosis of the liver. J Clin Ultrasound. 1989;17:563–8.

    CAS  PubMed  Google Scholar 

  59. Hickey AJ, Gounder L, Moosa MY, Drain PK. A systematic review of hepatic tuberculosis with considerations in human immunodeficiency virus co-infection. BMC Infect Dis. 2015;15:209.

    PubMed  PubMed Central  Google Scholar 

  60. Iwai T, Kida M, Kida Y, Shikama N, Shibuya A, Saigenji K. Biliary tuberculosis causing cicatricial stenosis after oral anti-tuberculosis therapy. World J Gastroenterol. 2006;12:4914–7.

    PubMed  PubMed Central  Google Scholar 

  61. Denaeghel D, Binet L, Wackenier P, Ravez P, Winant C. Paradoxical reaction in non HIV-tuberculosis, a rare case with pancreatic involvement. JBR-BTR. 2013;96:265.

    CAS  PubMed  Google Scholar 

  62. Falkowski AL, Graber J, Haack HG, Tarr PE, Rasch H. Isolated pancreatic tuberculosis: a case report and radiological comparison with cystic pancreatic lesions. J Radiol Case Rep. 2013;7:1–11.

    PubMed  PubMed Central  Google Scholar 

  63. Kim JB, Lee SS, Kim SH, et al. Peripancreatic tuberculous lymphadenopathy masquerading as pancreatic malignancy: a single- center experience. J Gastroenterol Hepatol. 2014;29:409–16.

    PubMed  Google Scholar 

  64. Rana SS, Sharma V, Sampath S, Sharma R, Mittal BR, Bhasin DK. Vascular invasion does not discriminate between pancreatic tuberculosis and pancreatic malignancy: a case series. Ann Gastroenterol. 2014;27:395–8.

    PubMed  PubMed Central  Google Scholar 

  65. Sharma V, Rana SS, Kumar A, Bhasin DK. Pancreatic tuberculosis. J Gastroenterol Hepatol. 2016;31:310–8.

    PubMed  Google Scholar 

  66. Panic N, Maetzel H, Bulajic M, Radovanovic M, Löhr JM. Pancreatic tuberculosis: a systematic review of symptoms, diagnosis and treatment. United European Gastroenterol J. 2020;17:2050640620902353. Epub ahead of print

    Google Scholar 

  67. Cho JK, Choi YM, Lee SS, et al. Clinical features and outcomes of abdominal tuberculosis in southeastern Korea: 12 years of experience. BMC Infect Dis. 2018;18:699.

    PubMed  PubMed Central  Google Scholar 

  68. Tan KK, Chen K, Sim R. The spectrum of abdominal tuberculosis in a developed country: a single institution’s experience over 7 years. J Gastrointest Surg. 2009;13:142–7.

    PubMed  Google Scholar 

  69. Ramesh J, Banait GS, Ormerod LP. Abdominal tuberculosis in a district general hospital: a retrospective review of 86 cases. QJM: Int J Med. 2008;101:189–95.

    CAS  Google Scholar 

  70. Singh A, Sahu MK, Panigrahi M, Behera MK, UthanSingh K, Kar C, Narayan J. Abdominal tuberculosis in Indians: still very pertinent. J Clin Tuber Other Mycobact Dis. 2019;15:100097.

    Google Scholar 

  71. Mandavdhare HS, Singh H, Dutta U, Sharma V. A real-world experience with 6 months of antitubercular therapy in abdominal tuberculosis. JGH Open. 2019;3:201–5.

    PubMed  PubMed Central  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  73. Sharma V, Soni H, Kumar-M P, Dawra S, Mishra S, Mandavdhare HS, Singh H, Dutta U. Diagnostic accuracy of the Xpert MTB/RIF assay for abdominal tuberculosis: a systematic review and meta-analysis. Expert Rev Anti-Infect Ther. 2020;19:1–3.

    Google Scholar 

  74. 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;56:178–83.

    PubMed  Google Scholar 

  75. Samant H, Desai D, Abraham P, George S. Acid-fast bacilli culture positivity and drug resistance in abdominal tuberculosis in Mumbai. India Indian J Gastroenterol. 2014;33:414–9.

    PubMed  Google Scholar 

  76. Sonambekar A, Desai D, Abraham P, Mehta V, Samant H, Joshi A, Gupta T, Rodrigues C. Drug resistance in intestinal tuberculosis: a reason to worry? JGH Open. 2017;1:22–4.

    PubMed  PubMed Central  Google Scholar 

  77. Ye BD, Yang S-K, Kim D, et al. Diagnostic sensitivity of culture and drug resistance patterns in Korean patients with intestinal tuberculosis. Int J Tuberc Lung Dis. 2012;16:799–804.

    CAS  PubMed  Google Scholar 

  78. Bellam BL, Mandavdhare HS, Sharma K, Shukla S, Soni H, Kumar-M P, Singh H, Prasad KK, Dutta U, Sharma V. Utility of tissue Xpert-Mtb/Rif for the diagnosis of intestinal tuberculosis in patients with ileocolonic ulcers. Ther Adv Infect Dis. 2019 Aug 7;6:2049936119863939. https://doi.org/10.1177/2049936119863939.

    Article  PubMed  PubMed Central  Google Scholar 

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Nath, P. (2022). Epidemiology of Gastrointestinal Tuberculosis. In: Sharma, V. (eds) Tuberculosis of the Gastrointestinal system. Springer, Singapore. https://doi.org/10.1007/978-981-16-9053-2_2

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