GI Tuberculosis

DEFINITION
Mycobacterium tuberculosis infection of the gastrointestinal tract.
See also tuberculosis (general) card.
See also TB peritonitis card.
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EPIDEMIOLOGY
Incidence
Rare in this part of the world.

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AETIOLOGY

Pathogenesis
TB can affect any part of the GI tract, from mouth to anus

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BIOLOGICAL BEHAVIOUR

Pathophysiology

Most commonly affected are ileum, proximal colon and peritoneum.

Classification

1. Ulcerated
- secondary to pulmonary TB (swallowing the mycobacteria)
- multiple deep transverse ulcers in terminal ileum
- overlying serosa thickened, reddened, covered in tubercles.
- healing may result in multiple strictures
- secondary bacterial overgrowth and malabsorption may occur

2. Hyperplastic
- ingestion of M. tb by pts with high resistance to the organism.
- (ie where the organism shows low virilance, typically after previous exposure).
- establishes in lymph follicles, thickening the wall and narrowing the lumen.
- early lymph node involvement, may caseate.
- usually ileocaecal, sometimes multiple in lower ileum.
- abscess and fistulae rare, otherwise quite like crohn's.

3. Fibrotic
- affects terminal ileum, caecum, ascending colon.
- shortening, narrowing of long segments.
- generalised peritoneal tuberculosis accompanies.


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MANIFESTATIONS

Symptoms


Local

Ulcerative
Diarrhoea & weight loss
Subacute obstructions.
Hyperplastic
Typically partial recurrent obstructions, colicky pain, vomiting.
Sometimes vague, eg thin pt, RIF mass, poor health.
Ileal compromise
Steatorrhoea, anaemia, wgt loss.

Systemic
Usual systemic features of TB.

Metastatic / Complications
Usually patient under treatment for pulmonary TB.
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INVESTIGATIONS

Imaging
Ulcerative
Narrowing and hypootility of the involved segment.
Ba Follow-through shows absence of filling of lower ieum, caecum, ascending colon.
Hyperplastic
Typically long narrow filling defect in the terminal ileum.

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MANAGEMENT

Medical
Antibiotics
Healing usually occurs provided pulmonary TB is adequately treated.

Operative
Only required usually if perforation or obstruction.
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REFERENCES
Bailey & Love.