Colonic tuberculosis: Clinical features, endoscopic appearance and management

Background: Although rare in the West, colonic tuberculosis is not an uncom mon disease in developing countries. However, the clinical manifestations a nd radiological appearance of the disease are non-specific. In recent years , colonoscopy has been found to be very useful in diagnosing patients with colonic tuberculosis. Methods: Clinical features, colonoscopic findings, histology and response t o treatment were recorded in 50 patients with colonic tuberculosis. Results: Abdominal pain, fever, anorexia, weight loss and diarrhoea were th e common symptoms. The colonoscopic features consisted of ulcers (92%), nod ules (88%), deformed caecum and ileocecal valve (42%), strictures (25%), mu ltiple fibrous bands (8%) and polypoid lesions (6%). Segmental tuberculosis and lesions simulating carcinoma were seen in 22 and 16% of patients, resp ectively. Histological examination of the colonic biopsy specimens showed w ell-formed, non-caseating granulomas in 18%, collection of loosely arranged epithelioid cells in 40% and chronic non-specific inflammatory changes in 42% of the patients. Six patients needed surgical intervention. The other 4 4 patients responded well to anti-tuberculous therapy and became asymptomat ic. Conclusions: It is concluded that colonoscopy is a useful method for diagno sing colonic tuberculosis. It is suggested that if the clinical picture and colonoscopic appearance are suggestive of tuberculosis and target biopsies reveal non-caseating granulomas, a collection of loosely arranged epitheli oid cells, or even non-specific changes, then a therapeutic trial of anti-t uberculous drugs should be given and continued if there is clinical improve ment. (C) 1999 Blackwell Science Asia Pty Ltd.