bowel TB versus crohns

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medchrt1
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   Posted 8/28/2009 7:43 PM (GMT -7)   

does anyone believe bowel TB is the same as crohns? If the only 2 characteristics are confluent and caseating for TB versus not confluent and not caseating granulomas for crohns... and they don't seem to be to sure about that either... these 2 disease seem very close, so has anyone received TB treatment first? and what were the meds and result?
 
[*I just activated the URL - C2]

Post Edited By Moderator (CrohnieToo) : 8/30/2009 12:46:42 AM (GMT-6)


Keeper
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   Posted 8/29/2009 11:52 AM (GMT -7)   
I don't think it could be the same. Maybe related (at a stretch), but since most people in the developed world are immunized against TB, it should not be the cause of CD. The western medical community has very little experience with TB and related syndromes - unlike the 3rd world where it is all too common. I doubt that any of them would consider treating as for TB. It might be done in India where both occur, but questions about the validity of the diagnosis would make any observations suspect.

medchrt1
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   Posted 8/30/2009 11:25 AM (GMT -7)   
The US is developed and according to websites, the US does not vaccinate for TB, (eg. http://www.chop.edu/consumer/jsp/division/generic.jsp?id=75735 ) so I am not so sure about how to interpret your vaccination statement. As far as treatment, the 5-ASA (5-aminosalicylate) drugs are second line meds for TB. (http://en.wikipedia.org/wiki/Tuberculosis_treatment). I am sure alot of people have taken 5-ASA. (Asacol, Pentasa...) Your statement regarding..."It might be done in India where both occur," is therefore inaccurate (where infact...there is clearly 5ASA drugs used for crohns... and the fact that 5-ASA is shown as second line for TB is not a coincidence to me)... you also follow up with ..." but questions about the validity of the diagnosis would make any observations suspect." which I didn't understand. The bottom line is I wanted to know the regimen..especially if anyone has taken the first line TB drugs for crohns and had success. (or have taken these meds for any bowel situation for that matter)
Thel first-line anti-tuberculous drug names :

* ethambutol is EMB or E,
* isoniazid is INH or H,
* pyrazinamide is PZA or Z,
* rifampicin is RMP or R,
* streptomycin is STM or S.
After 20 years of having my bowels slowly removed I wanted to know why I hadnt received the TB 1st line med regimen. This would point to the pathology report and the interpretation of the stains I suppose, but if one fundamentally believes both stains are achievable for both diseases then there is no reason to seperate TB regimen 1st line drugs.

medchrt1
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   Posted 8/30/2009 12:23 PM (GMT -7)   
http://www.nature.com/ajg/journal/v93/n11/full/ajg1998530a.html

medchrt1
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   Posted 8/30/2009 12:45 PM (GMT -7)   
http://www.medicalnewstoday.com/articles/145362.php

"One-third of the world's population is latently infected with M. tuberculosis."

Keeper
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   Posted 8/30/2009 2:43 PM (GMT -7)   
The doctors commonly order a test for TB before prescribing immune suppressing meds, so I would expect that it should be discovered then, if not before. I see from your link that the case reported did not show a positive test for TB despite later diagnosis of TB. It does sound like there is a distinct possibility that the two could be confused, but the severity of intestinal TB would result in fairly quick loss of intestinal function and manifestation at other sites like the lungs. The one-third of the world's population with latent TB mostly live in third world countries. The article seems to indicate that the risk is mostly for immune-compromised individuals (AIDS, etc) or people from third world countries. Certainly you might want to ask your GI about the likelihood of TB, but I imagine that he would want to test samples from a colonoscopy/biopsy before going that route.

medchrt1
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Date Joined Sep 2005
Total Posts : 517
   Posted 8/30/2009 3:32 PM (GMT -7)   
Expect what was discovered? That a positive test means you were vaccinated for TB, or that you in fact have the disease?

The link I posted, is of many cases that have difficulty in determining diagnosis. For the sake of others reading this...that is why alot is said for understanding the pathology from the biopsy, so if you are in the diagnosis stage that is important. I will need to dig up my reports to practice what I preach. and read more carefully the features of the granulomas from 1988 and how extensive they were considered.
Regarding severity... I can say the same thing about the severity aspect of crohns. Also, I dont see any evidence suggesting the TB manifestation /continuing to the lungs when it begins in the bowel, in fact the diagnosis difficulties would make that study difficult, or, can you point out the evidence which shows TB bowel problems more in severity than crohns? If that is true ...that it [TB] eventually manifests in lungs then the chest xray would be the examine solution to that disease route, if it does make that spread. I dont think it does necessarily. This idea of third world is an attempt to separate the population medically and is quite impossible with influx of foreigners, travel etc. Speculation on which countries is receiving the benefits of vaccine is a leap beyond knowing what the disease is in the first place.

I appreciate your responses as it does help me to focus.

Keeper
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Date Joined Jun 2008
Total Posts : 1058
   Posted 8/30/2009 8:42 PM (GMT -7)   
The test is for latent TB, although it can be confused by previous TB vaccine immunization.

The difficulty of identifying TB is a problem, but it does move around the body and one of the subjects in the papers you link to was diagnosed by culture of a lung sample which appeared after serious damage was done to the ileocecal valve. There are visible traits that identify lesions of TB and although there are false negatives in a significant number of culture tests, it is not so rare that it would be outside of a pathologist's experience. Even the US sees a rate of TB that is about 40 per 100,000 each year, or 120,000 cases per year nationwide. One other trait that TB has is that intestinal lesions appear to be like lesions associated with bowel cancer. This is rarely true of Crohn's.

TB is more a problem for people with some immune compromise, which is why they test for latent TB before starting therapy with immune suppressors. Info on Wikipedia suggests that 90% of people with TB show no symptoms (latent TB) and of those, only 10% will progress to TB in their lifetime (See: Wikipedia).
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