Gastrointestinal tuberculosis: A systematic review of epidemiology, presentation, diagnosis and treatment

Abstract

Tuberculosis (TB) once considered a disease of the developing world is infrequent in the developing world too. Its worldwide prevalence with a huge impact on the healthcare system both in economic and health terms has prompted the World Health Organization to make it a top priority infectious disease. Tuberculous infection of the pulmonary system is the most common form of this disease, however, extrapulmonary TB is being increasingly recognized and more often seen in immunocompromised situations. Gastrointestinal TB is a leading extrapulmonary TB manifestation that can defy diagnosis. Overlap of symptoms with other gastrointestinal diseases and limited accuracy of diagnostic tests demands more awareness of this disease. Untreated gastrointestinal TB can cause significant morbidity leading to prolonged hospitalization and surgery. Prompt diagnosis with early initiation of therapy can avoid this. This timely review discusses the epidemiology, risk factors, pathogenesis, clinical presentation, current diagnostic tools and therapy.

Keywords: Abdominal tuberculosis; clinical features; diagnosis; extrapulmonary tuberculosis; gastrointestinal tuberculosis; pathogenesis; risk factors; treatment; tuberculosis.

Figure 1

Spread of pulmonary TB to abdomen

Figure 2

Mycobacterium invades the submucosa leading to formation of granulomas, vasculitis and hypertrophy, which in turn cause ulcers, perforation, fistulas and abscess formation

Figure 3

Constitutional and local symptoms/signs due to GITB

Figure 4

Different sites involved in GITB with associated symptoms

Figure 5

Diagnostic accuracy of histopathology for GITB

Figure 6

Diagnostic accuracy of AFB on biopsy smear

Figure 7

Microbiological Diagnostic accuracy for intestinal biopsy