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Crohn's vs GI Tuberculosis

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Crohn's Disease
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Posted 2/25/2009 1:00 AM (GMT 0)

Did anyone discuss with your doc to test for GI Tuberculosis. If so, what are your experiences?

I was dxed with CD in 2004 ... on pentasa for 4 years. After last colonoscopy in july 2008 was put on MTX(15mg/week). Went for second opinion ... seeing my medical history, the new GI said I was not being treated properly ... so going trhu new tests. I still have issues with malabsorption, weightloss and anemia with me eating good calories and taking Ensure plus twice a day ... don't have diarrhea.

Yesterday, went for a smallbowel follow-through. At the end of test, the radiologist mentioned abt CD vs GI TB. Today, was reading about it on the net. GI TB being rare in US/western countries, there isn't much information about it. But the symptoms of the GI TB are strikingly similar to CD (Anemia, weightloss, rectalbleeding, diarrhea, malabsorption)

I didn't get to speak with my new GI regd the small bowel results yet ... but I will definitely bring up this TB possibility with him.

Not trying to open a discussion on MAP(cows milk etc) link... the TB I am talking abt is caused by Mycobacterium Tuberculosis .. the real bacterium.

Posted 2/25/2009 11:28 AM (GMT 0)
P -- That's an interesting thought. What do the biopsies from your scope(if they were done) show? I don't have alot of faith in radiologists comments during SBFT here's why...........about 3 years ago (when I was in a full blown flare) the radiologist doing my SBFT commented that I couldn't possibly have Crohn's because there was no looping (still not sure what that meant). I was diagonsed in 1982 so the no CD comment was completely off the wall and in my opinion inappropriate. So, I'd wait and talk to your GI for the results and bring up the possiblility of GI TB. Let us know what GI has to say.
Posted 2/25/2009 5:29 PM (GMT 0)
I also mentioned to my GI about GI TB. He sort of dismissed it. But, I was exposed to regular TB in the 80s. I took INH to kill the TB for a year back in 1990... But, when it comes to my gut and the fact that none of the Crohn's meds are working for me, I do wonder. You've reminded me to talk to my other doctor about it.

I'd love to hear what you find out as you pursue the information!
Posted 2/27/2009 12:50 AM (GMT 0)
Today, I had my appointment with my new GI doc to discuss SBFT(SmallBowel is clear but ileum is inflamed) and I did brought up the TB issue.

According to him - "when Ileo-cecal is inflamed(which in my case. it was), they check for Granulomas in the region, which differentiates between presence CD or TB. In my case, the biopsies of previous two scopes and the SBFT didn't indicate any granulomas, so TB is out of question. SBFT follwed by CT scan is used for diagnosing GI TB. Also, in case of TB, the symptoms are much worse with fever and it would have been obvious to any doc". He said, he checked because I come from a high-risk region for TB and he mentioned he treated patients with GI TB before.

Changed my medications to Lialda, Pred and Flagyl for next six months. And no more MTX :-) .
Posted 2/27/2009 3:47 AM (GMT 0)
does a tb skin test show positive for GI TB?
Posted 2/27/2009 4:55 AM (GMT 0)
Well, if it would be obvious to any doc, then I guess I'm stuck with Crohn's! ;-) Thanks for the info. I've wondered about that for a while now...
Posted 5/17/2010 3:59 AM (GMT 0)
skin test (PPD) will work to detect gastrointestinal TB, but it's unreliable if you're on immunosuppressive drugs. you would need to get a blood test called quantiferon gold. you can also get acid fast staining on your pathology slides to look for the mycobacteria. it's unlikely you have TB in your GI tract as you would be very sick (fevers, night sweats, weight loss) and have ascites (a big swollen belly) most likely too.
Posted 5/18/2010 2:11 PM (GMT 0)
Doctors in the developing world, esp in Asia strongly believe mostly or almost all GI ailments have a bacteriological or virological roots. So they do zone in on GI TB quite a bit, but doctors around here are quite dismissive of it and apparently it is very hard to diagnose it. And yes, another symptom is that if you are being treated with immuno-suppressants including biologicals and steroids, I guess it is not TB because if you have TB then the reactions to such drugs are apparently severe. But, if it GI TB it is someways easy to treat because the infected portion could be surgically removed and then one could be treated with a long-course of antibiotics and then it is diet. CD is more difficult and chronic to treat...

More thoughts?

Yes, GI TB cannot be detected with skin test or even a chest x-ray.
Posted 5/18/2010 7:21 PM (GMT 0)
Back in the dim dark ages, my great uncle was thought to have GI tuberculosis, of course he was not tested for it, not sure they even tested for it then. But he's the one my family blames for the Crohn's gene, so we all think it was Crohn's not TB. There are at least 4 of us with IBD, and we have a really small family, so percentage wise its a lot.
Posted 5/19/2010 12:26 AM (GMT 0)
pxsk-the radiologist might also be referring to the genus Mycobacterium which has been hypothesized as one of the causative agents for crohn's disease (MAP)... there has been a lot of discussion about this on this forum, and the evidence remains unclear at this time...but I did link and article...
ibdcrohns.about.com/od/crohnsdisease/a/map.htm
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