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Gastrointestinal tuberculosis
Singapore Medical Journal, 07/01/09

Chong VH et al. - Tuberculosis (TB) infection is still common and remains an important cause of morbidity and mortality, particularly in underdeveloped and developing nations. The gastrointestinal (GI) tract is the sixth commonest extrapulmonary site to be affected after lymphatic, genitourinary, bones and joints, miliary and meningeal involvement. Manifestations can be non-specific and mimic many conditions, including malignancies. Findings from endoscopy and radiological imaging are myriad, and depend on the stage of the disease and the time at which investigations are carried out. Hence, diagnosis can be difficult. Endoscopy is now the investigation of choice as it allows for visualisation and the sampling of tissue for histology and culture. This is complemented by radiological imaging. This pictorial essay reviews some of the endoscopic and radiological findings of non-human immunodeficiency virus associated proven GI TB infections that the authors have encountered in a tertiary referral centre.

Exclusive Author Commentary
Vui Heng Chong, 07/02/09

From my experience with TB, one has always have to consider this diagnosis to prevent misdiagnosis. There are many features on imagings suggest possibility of TB as the underlying etiology of patient's illness. Imaging findings of either old or active pulmonary TB is important. Similarly, findings of calcifications in the hepatic parenchyma should also be investigated for TB infection. Blood investigations are also important. In our experience, a diagnosis of TB which ever organ is affected can be made early as long as the diagnosis is considered and ever attemtps are made to obtain tissue for histology or culture; investigations such as endoscopy, percutaneous biopsy, bronchoscopy etc.. It is also important to remember that multi organ involvements are not uncommon especially if one look for them. In addition to the Pictorial essay on GI TB, we have also have an article on a pictorial essay on hepatobiliary TB due to be published soon.

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