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Do additional colonoscopic biopsies increase the yield of Mycobacterium tuberculosis culture in suspected ileo-colonic tuberculosis?

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Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Isolation of Mycobacterium tuberculosis on culture is vital for differentiating intestinal tuberculosis (ITB) from Crohn’s disease (when histology is not diagnostic) and for diagnosis of multidrug-resistant tuberculosis. The current yield of TB culture (< 50%) from colonoscopic biopsy tissue is not satisfactory.

Aim

To determine whether more colonoscopic biopsies can increase the yield of TB culture in patients with ITB.

Methods

In this prospective study, in patients who underwent colonoscopy for suspected ITB, four biopsies were taken (container 1) followed by an additional four biopsies (container 2) for TB culture, from involved regions. The culture was done using Mycobacterium Growth Indicator Tube (MGIT) 960. A final diagnosis of ITB was made if TB culture was positive, there was unequivocal histological evidence of TB, or there was unequivocal evidence of TB elsewhere in the body, in the absence of another diagnosis.

Results

Of 182 patients enrolled (mean age 37.5 [SD 17.2] years; 93 [51.5%] women), 70 (38.4%) were finally diagnosed to have ITB. MGIT culture was positive in 29 (41.4%), 27 (38.5%), and 37 (52.8%) of 70 patients from containers 1, container 2, and combined eight biopsies, respectively. The incremental yield of eight biopsies was 11.4% (95% confidence interval [CI] 5.1 to 21.3%) as compared to container 1 and 14.3% (95% CI 7.1 to 24.7%) as compared to container 2.

Conclusion

Additional four (total eight) colonoscopic biopsies improved the yield of TB culture positivity over four biopsies by 11.4% to 14.3%, to 52.8%; this increase is clinically useful.

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Acknowledgements

We gratefully acknowledge the help received from Dr. Arun Nanivadekar and from Dr. Sudeep Shah and Dr. Lancelot Pinto (P D Hinduja Hospital) for the statistical inputs and Dr. Rajiv Baijal, Department of Gastroenterology, Jagjivan Ram Hospital, for sending samples for TB culture.

Contribution of authors

Vatsal Mehta: analysis and interpretation of data and drafting of the manuscript. Devendra Desai: concept and study design, study supervision, analysis and interpretation of data, and drafting and critical revision of the manuscript. Philip Abraham: interpretation of data and critical revision of the manuscript. Camilla Rodrigues: blinded conduct of microbiology studies. Ramesh Deshpande: blinded conduct of histology studies. All authors: acquisition of data and approval of final manuscript.

Funding

The study was funded by the National Health and Education Society, P D Hinduja Hospital, Mumbai 400 016, India.

Author information

Authors and Affiliations

  1. Division of Gastroenterology, P D Hinduja Hospital, Veer Savarkar Marg, Mahim, Mumbai, 400 016, India

    Vatsal Mehta, Devendra Desai, Philip Abraham, Tarun Gupta & Anand Joshi

  2. Division of Microbiology, P D Hinduja Hospital, Veer Savarkar Marg, Mahim, Mumbai, 400 016, India

    Camilla Rodrigues

  3. Division of Pathology, P D Hinduja Hospital, Veer Savarkar Marg, Mahim, Mumbai, 400 016, India

    Ramesh Deshpande

  4. Department of Gastroenterology, Lokmanya Tilak Municipal General Hospital, Mumbai, 400 022, India

    Prabha Sawant & Mehgraj Ingle

  5. Department of Gastroenterology, B Y L Nair Hospital, Mumbai, 400 008, India

    Pravin Rathi

  6. Department of Gastroenterology, Bombay Hospital, Mumbai, 400 020, India

    Ameet Mandot

Authors
  1. Vatsal Mehta
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  2. Devendra Desai
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  3. Philip Abraham
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  4. Tarun Gupta
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  5. Camilla Rodrigues
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  6. Anand Joshi
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  7. Ramesh Deshpande
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  8. Prabha Sawant
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  9. Mehgraj Ingle
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  10. Pravin Rathi
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  11. Ameet Mandot
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Corresponding author

Correspondence to Devendra Desai.

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Conflict of interest

VM, DD, PA, TG, CR, AJ, RD, PS, MI, PR, and AM declare that they have no conflict of interest.

Ethics statement

The authors declare that the study was conducted conforming to the Declaration of Helsinki, 1975 (and subsequent revisions) for human rights. Written informed consent was obtained from all participating subjects, and the protocol was reviewed and approved by the institution’s ethics committee. The study was registered to the Clinical Trials Registry - India.

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Mehta, V., Desai, D., Abraham, P. et al. Do additional colonoscopic biopsies increase the yield of Mycobacterium tuberculosis culture in suspected ileo-colonic tuberculosis?. Indian J Gastroenterol 37, 226–230 (2018). https://doi.org/10.1007/s12664-018-0863-8

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  • DOI: https://doi.org/10.1007/s12664-018-0863-8

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