Colonoscopy in the diagnosis of intestinal tuberculosis in asymptomatic patients.
BACKGROUND
Colonoscopy with terminal ileoscopy is crucial for the diagnosis of intestinal tuberculosis. This report describes characteristic endoscopic findings in patients with intestinal tuberculosis with few or no clinical symptoms.


METHODS
Data for 11 consecutive patients in whom a diagnosis of intestinal tuberculosis was made during the last 15 years in one facility were reviewed. Clinical findings and the frequency of endoscopic findings were evaluated. Mucosal lesions were classified into 4 types: type 1, circumferential ulceration with nodules; type 2, round or irregularly shaped small ulcers, arranged circumferentially, without nodules; type 3, multiple erosions restricted to the large intestine; and type 4, small ulcers or erosions restricted to the ileum. The gross endoscopic appearance of healed lesions included patulous ileocecal valve, pseudodiverticular deformity, and atrophic mucosal areas with aggregated ulcer scars.


RESULTS
Only one patient had remarkable clinical symptoms (anorexia and weight loss), whereas, the other 10 had few or no symptoms. The frequency of type 1, 2, 3, and 4 endoscopic findings was, respectively, 36%, 36%, 9%, and 18%. The frequencies for patulous ileocecal valve, pseudodiverticular deformity, and atrophic mucosal area were, respectively, 45%, 45%, and 91%.


CONCLUSIONS
When colonoscopy is performed in asymptomatic patients, it is important to be aware of subtle endoscopic findings that are characteristic for intestinal tuberculosis. Recognition of such findings may lead to a correct diagnosis of early stage intestinal tuberculosis.
Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka Medical Clinic, Nishi-Fukuoka Hospital, Fukuoka, Japan.
Shigeru
S
Sato
Kenshi
K
Yao
Tsuneyoshi
T
Yao
Ronald J
RJ
Schlemper
Toshiyuki
T
Matsui
Toshihiro
T
Sakurai
Akinori
A
Iwashita
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D001707:Biopsy, Needle; D003108:Colonic Diseases / Q000175:diagnosis* / Q000188:drug therapy; D003113:Colonoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007413:Intestinal Mucosa / Q000382:microbiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis* / Q000188:drug therapy
D000995:Antitubercular Agents