title: Clinical presentation of abdominal tuberculosis in HIV seronegative adults.
abstract: 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.
authors.affiliation: Gastroenterology Division, Department of Internal Medicine, Faculty of Medicine, Harran University, Sanliurfa, Turkey. drcengizbolukbas@hotmail.com
authors.forename: Cengiz
authors.initials: C
authors.lastname: Bolukbas
authors.forename: Fusun F
authors.initials: FF
authors.lastname: Bolukbas
authors.forename: Tulin
authors.initials: T
authors.lastname: Kendir
authors.forename: Remzi A
authors.initials: RA
authors.lastname: Dalay
authors.forename: Nihat
authors.initials: N
authors.lastname: Akbayir
authors.forename: Mehmet H
authors.initials: MH
authors.lastname: Sokmen
authors.forename: Ali T
authors.initials: AT
authors.lastname: Ince
authors.forename: Mithat
authors.initials: M
authors.lastname: Guran
authors.forename: Erkan
authors.initials: E
authors.lastname: Ceylan
authors.forename: Guray
authors.initials: G
authors.lastname: Kilic
authors.forename: Oya
authors.initials: O
authors.lastname: Ovunc
mesh_terms: 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