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Meta-Analysis
. 2023 Feb 23;23(1):46.
doi: 10.1186/s12876-023-02682-x.

Frequency, outcomes, and need for intervention in stricturing gastrointestinal tuberculosis: a systematic review and meta-analysis

Anuraag Jena  1 , Ritin Mohindra  2 , Kirtan Rana  3 , Pardhu B Neelam  1 , Dhuni Chand Thakur  2 , Harjeet Singh  4 , Pankaj Gupta  5 , Vikas Suri  2 , Vishal Sharma  6
Affiliations
Meta-Analysis

Frequency, outcomes, and need for intervention in stricturing gastrointestinal tuberculosis: a systematic review and meta-analysis

Anuraag Jena et al. BMC Gastroenterol. .

Abstract

Background: Gastrointestinal strictures impact clinical presentation in abdominal tuberculosis and are associated with significant morbidity.

Aim: To conduct a systematic review of the prevalence of stricturing disease in abdominal and gastrointestinal tuberculosis and response to antitubercular therapy (ATT).

Methods: We searched Pubmed and Embase on 13th January 2022, for papers reporting on the frequency and outcomes of stricturing gastrointestinal tuberculosis. The data were extracted, and pooled prevalence of stricturing disease was estimated in abdominal tuberculosis and gastrointestinal (intestinal) tuberculosis. The pooled clinical response and stricture resolution (endoscopic or radiologic) rates were also estimated. Publication bias was assessed using the Funnel plot and Egger test. The risk of bias assessment was done using a modified Newcastle Ottawa Scale.

Results: Thirty-three studies reporting about 1969 patients were included. The pooled prevalence of intestinal strictures in abdominal tuberculosis and gastrointestinal TB was 0.12 (95%CI 0.07-0.20, I2 = 89%) and 0.27 (95% CI 0.21-0.33, I2 = 85%), respectively. The pooled clinical response of stricturing gastrointestinal tuberculosis to antitubercular therapy was 0.77 (95%CI 0.65-0.86, I2 = 74%). The pooled stricture response rate (endoscopic or radiological) was 0.66 (95%CI 0.40-0.85, I2 = 91%). The pooled rate of need for surgical intervention was 0.21 (95%CI 0.13-0.32, I2 = 70%), while endoscopic dilatation was 0.14 (95%CI 0.09-0.21, I2 = 0%).

Conclusion: Stricturing gastrointestinal tuberculosis occurs in around a quarter of patients with gastrointestinal tuberculosis, and around two-thirds of patients have a clinical response with antitubercular therapy. A subset of patients may need endoscopic or surgical intervention. The estimates for the pooled prevalence of stricturing disease and response to ATT had significant heterogeneity.

Keywords: Abdominal tuberculosis; Crohn's disease; Gastrointestinal tuberculosis; Intestinal tuberculosis; Peritoneal tuberculosis; Tuberculous peritonitis.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
The PRISMA flow chart showing the process of screening and selection of eligible studies
Fig. 2
Fig. 2
Forest Plot showing the pooled prevalence of stricturing disease in patients with gastro-intestinal tuberculosis
Fig. 3
Fig. 3
Forest Plot showing the pooled clinical response rates to anti-tubercular therapy in patients with stricturing gastrointestinal tuberculosis
Fig. 4
Fig. 4
Forest Plot showing the pooled stricture response rates to anti-tubercular therapy in patients with stricturing gastrointestinal tuberculosis
Fig. 5
Fig. 5
Forest plot showing the pooled rates of a endoscopic dilatation b surgery in patients with stricturing gastrointestinal tuberculosis
Fig. 6
Fig. 6
Pictorial depiction of the summary of findings of the systematic review
See this image and copyright information in PMC

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