title: Effectiveness of interferon-gamma release assays for differentiating intestinal tuberculosis from Crohn's disease: a meta-analysis.
abstract: OBJECTIVE
  To investigate the clinical usefulness of interferon-gamma release assays (IGRAs) in the differential diagnosis of intestinal tuberculosis (ITB) from Crohn's disease (CD) by meta-analysis.
  
  
  METHODS
  A systematic search of English language studies was performed. We searched the following databases: Medline, Embase, Web of Science and the Cochrane Library. The Standards for Reporting Diagnostic Accuracy initiative and Quality Assessment for Studies of Diagnostic Accuracy tool were used to assess the methodological quality of the studies. Sensitivity, specificity, and other measures of the accuracy of IGRAs in the differential diagnosis of ITB from CD were pooled and analyzed using random-effects models. Receiver operating characteristic curves were applied to summarize overall test performance. Two reviewers independently judged study eligibility while screening the citations.
  
  
  RESULTS
  Five studies met the inclusion criteria. The average inter-rater agreement between the two reviewers for items in the quality checklist was 0.95. Analysis of IGRAs for the differential diagnosis of ITB from CD produced summary estimates as follows: sensitivity, 0.74 (95%CI: 0.68-0.80); specificity, 0.87 (95%CI: 0.82-0.90); positive likelihood ratio, 5.98 (95%CI: 3.79-9.43); negative likelihood ratio, 0.28 (95%CI: 0.18-0.43); and diagnostic odds ratio, 26.21 (95%CI: 14.15-48.57). The area under the curve was 0.92. The evaluation of publication bias was not significant (P = 0.235).
  
  
  CONCLUSIONS
  Although IGRAs are not sensitive enough, they provide good specificity for the accurate diagnosis of ITB, which may be helpful in the differential diagnosis of ITB from CD.
authors.affiliation: Wen Chen, Department of Educational Administration, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Chen
authors.forename: Jun-Hua
authors.initials: JH
authors.lastname: Fan
authors.forename: Wei
authors.initials: W
authors.lastname: Luo
authors.forename: Peng
authors.initials: P
authors.lastname: Peng
authors.forename: Si-Biao
authors.initials: SB
authors.lastname: Su
mesh_terms: D019540:Area Under Curve; D016009:Chi-Square Distribution; D003424:Crohn Disease / Q000175:diagnosis* / Q000276:immunology; D003937:Diagnosis, Differential; D006801:Humans; D059425:Interferon-gamma Release Tests; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012372:ROC Curve; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology
keywords: Crohn’s disease; Interferon-gamma; Intestinal tuberculosis; Meta-analysis