Differences Between Intestinal Tuberculosis and Crohn's Disease

Intestinal tuberculosis and Crohn's disease share many similar clinical manifestations, including symptoms such as abdominal pain, diarrhea, abdominal masses, and constipation. However, there are several key distinctions between the two conditions that help in accurate diagnosis and treatment planning.

Extraintestinal Manifestations

Intestinal tuberculosis often presents with extraintestinal signs of tuberculosis. For example, patients may experience symptoms of pulmonary tuberculosis, such as chronic coughing. On the other hand, Crohn's disease is associated with various extraintestinal symptoms including recurrent oral ulcers, joint pain, skin rashes, and the formation of fistulas.

Endoscopic Findings

Endoscopically, intestinal tuberculosis typically affects the ileocecal region and surrounding tissues. Circular ulcers are commonly observed in cases of intestinal tuberculosis. In contrast, Crohn's disease often presents with segmental, fissure-like ulcers in the terminal ileum.

Pathological Features

From a pathological perspective, intestinal tuberculosis is characterized by caseating granulomas and positive acid-fast staining. Crohn's disease, however, features non-caseating granulomas and tests negative on acid-fast staining. These histological differences are crucial for differentiating the two conditions.

Imaging Techniques

Imaging studies such as CT scans and small bowel contrast imaging can also aid in distinguishing between the two diseases. Intestinal tuberculosis typically shows relatively symmetric bowel wall thickening. In contrast, Crohn's disease tends to involve more extensive and irregular segmental wall thickening.

Laboratory Tests

Blood tests play a significant role in the diagnostic process. Tests such as the PPD skin test, tuberculosis antibodies, T-SPOT assay, or molecular diagnostics can provide valuable insights in differentiating between intestinal tuberculosis and Crohn's disease.