Journal
INFLAMMATORY BOWEL DISEASES
Volume 17, Issue 6, Pages 1308-1313Publisher
OXFORD UNIV PRESS INC
DOI: 10.1002/ibd.21490
Keywords
intestinal tuberculosis; Crohn's disease; diagnosis; interferon-gamma assay; tuberculin skin test
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Funding
- Ministry for Health, Welfare & Family Affairs, Republic of Korea [A080588]
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Background: Distinguishing intestinal tuberculosis (ITB) from Crohn's disease (CD) is challenging. This study prospectively evaluated the clinical utility of the QuantiFERON-TB gold test (QFT) in the differential diagnosis of ITB and CD, and compared it with the clinical utility of the tuberculin skin test (TST). Methods: Patients with suspected ITB or CD on colonoscopic findings were enrolled from 13 hospitals in Korea between June 2007 and November 2008. A QFT and TST were performed. When the initial diagnosis was not confirmed, 2-3 months of empiric antituberculous therapy was administered. Results: In all, 128 patients were analyzed; 64 patients had ITB and 64 patients had CD. The median age of patients with ITB was greater than the patients with CD (47 years versus 31 years, P < 0.001). The positive rate for the QFT and TST (>= 10 mm) in patients with ITB was significantly higher than patients with CD (67% versus 9% and 69% versus 16%, respectively; P < 0.001). The QFT and TST had good agreement (kappa = 0.724, P < 0.001). The diagnostic validity of QFT in ITB had a 67% sensitivity, 90% specificity, 87% positive predictive value, and 73% negative predictive value. There was no difference in these parameters between the QFT and TST. The likelihood ratio for a positive QFT was higher than a positive TST in the diagnosis of ITB (7.1 and 4.4, respectively). Conclusions: The QFT is a limited but useful diagnostic aid in combination with the TST in the diagnosis of ITB.
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