Clinical presentation of abdominal tuberculosis in HIV seronegative adults.
BACKGROUND
The accurate diagnosis of abdominal tuberculosis usually takes a long time and requires a high index of suspicion in clinic practice. Eighty-eight immune-competent patients with abdominal tuberculosis were grouped according to symptoms at presentation and followed prospectively in order to investigate the effect of symptomatic presentation on clinical diagnosis and prognosis.


METHODS
Based upon the clinical presentation, the patients were divided into groups such as non-specific abdominal pain & less prominent in bowel habit, ascites, alteration in bowel habit, acute abdomen and others. Demographic, clinical and laboratory features, coexistence of pulmonary tuberculosis, diagnostic procedures, definitive diagnostic tests, need for surgical therapy, and response to treatment were assessed in each group.


RESULTS
According to clinical presentation, five groups were constituted as non-specific abdominal pain (n = 24), ascites (n = 24), bowel habit alteration (n = 22), acute abdomen (n = 9) and others (n = 9). Patients presenting with acute abdomen had significantly higher white blood cell counts (p = 0.002) and abnormalities in abdominal plain radiographs (p = 0.014). Patients presenting with alteration in bowel habit were younger (p = 0.048). The frequency of colonoscopic abnormalities (7.5%), and need for therapeutic surgery (12.5%) were lower in patients with ascites, (p = 0.04) and (p = 0.001), respectively. There was no difference in gender, disease duration, diagnostic modalities, response to treatment, period to initial response, and mortality between groups (p > 0.05). Gastrointestinal tract alone was the most frequently involved part (38.5%), and this was associated with acid-fast bacteria in the sputum (p = 0.003).


CONCLUSIONS
Gastrointestinal tract involvement is frequent in patients with active pulmonary tuberculosis. Although different clinical presentations of patients with abdominal tuberculosis determine diagnostic work up and need for therapeutic surgery, evidence based diagnosis and consequences of the disease does not change.
Bolukbas
Cengiz
C
Gastroenterology Division, Department of Internal Medicine, Faculty of Medicine, Harran University, Sanliurfa, Turkey. drcengizbolukbas@hotmail.com
Bolukbas
Fusun F
FF
Kendir
Tulin
T
Dalay
Remzi A
RA
Akbayir
Nihat
N
Sokmen
Mehmet H
MH
Ince
Ali T
AT
Guran
Mithat
M
Ceylan
Erkan
E
Kilic
Guray
G
Ovunc
Oya
O
D000006:Abdomen, Acute / Q000209:etiology; D015746:Abdominal Pain / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D001201:Ascites / Q000209:etiology*; D003113:Colonoscopy; D003248:Constipation / Q000209:etiology*; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000209:etiology*; D005260:Female; D018023:HIV Seronegativity; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D014385:Tuberculosis, Gastrointestinal / Q000150:complications* / Q000175:diagnosis* / Q000276:immunology; D014397:Tuberculosis, Pulmonary / Q000150:complications