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Temporal trends in the misdiagnosis rates between Crohn's disease and intestinal tuberculosis

World Journal of Gastroenterology 2017年第34期23卷 6306-6314页

作者： Hyungil Seo Seohyun Lee hoonsub so Donghoi Kim Seon-Ok Kim Jae Seung soh Jung Ho Bae Sun-Ho Lee Sung Wook Hwang Sang Hyoung Park Dong-Hoon Yang Kyung-Jo Kim Jeong-Sik Byeon Seung-Jae Myung Suk-Kyun Yang Byong Duk Ye Department of Gastroenterology University of Ulsan College of MedicineAsan Medical Center Division of Gastroenterology Department of Internal MedicineCenter for Health PromotionSeoul National University Hospital Department of Clinical Epidemiology and Biostatistics University of Ulsan College of MedicineAsan Medical Center Division of Gastroenterology Department of Internal MedicineHallym University College of Medicine Hallym University Sacred Heart Hospital Department of Gastroenterology Seoul National University College of MedicineSeoul National University Hospital Gangnam Center Inflammatory Bowel Disease Center University of Ulsan College of MedicineAsan Medical Center

AIM To investigate the temporal trends in the misdiagnosis rate between Crohn's disease(CD) and intestinal tuberculosis(ITB) in south Korea. METHODS We retrospectively reviewed the medical records of patients managed for CD or ITB at Asan Medical Center, a tertiary referral hospital, Seoul, Korea between 1996 and 2014. The temporal trends in the misdiagnosis rates between the two diseases were analyzed. The demographic and clinical characteristics were compared between CD patients who were initially misdiagnosed as ITB(final CD group) and vice versa(final ITB group). Final diagnostic criteria for ITB and medication for CD before definite diagnosis of TB were also analyzed in final ITB *** In total, 2760 patients were managed for CD and 772 patients for ITB between 1996 and 2014. As well, 494 of the 2760 CD patients(17.9%) were initially misdiagnosed as ITB and 83 of the 772 ITB patients(10.8%) as CD. The temporal trend in misdiagnosing CD as ITB showed a decrease(OR = 0.89, 95%CI: 0.87-0.91, P < 0.001), whereas the temporal trend in misdiagnosing ITB as CD showed an increase(OR = 1.06, 95%CI: 1.01-1.11, P = 0.013). Age at diagnosis, presenting symptoms, and proportion of patients with active/past perianal fistula and active/inactive pulmonary tuberculosis(TB) were significantly different between final CD group and final ITB group. Forty patients(48.2%) in final ITB group were diagnosed by favorable response to empirical anti-TB treatment. Seventeen patients(20.5%) in final ITB group had inappropriately received corticosteroids and/or thiopurines due to misdiagnosis as CD. However, there were no mortalities in both groups. CONCLUSION Cases of CD misdiagnosed as ITB have been decreasing, whereas cases of ITB misdiagnosed as CD have been increasing over the past two decades.

关键词： Crohn’s disease Intestinal tuberculosis Misdiagnosis

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