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- W4367481978 abstract "Dr V K Kapoor is right to say1 that tuberculosis, ‘the great mimic’, should be considered in the differential diagnosis of patients with ileo-caecal disease.2, 3 It may indeed be difficult to differentiate tuberculosis from Crohn's disease but other conditions, such as intestinal lymphoma, cancer of the caecum or Strongyloides stercoralis infection should also be considered; these too may be indistinguishable on barium studies or CT scanning. We believe that in Western communities, where Crohn's disease has an incidence of up to 10 per 100,000 person years,4 patients with a clinical picture and radiology compatible with Crohn's disease should be treated in this way without necessarily obtaining histological proof. Exceptions should be those who are obviously immunosuppressed or have calcific lymph nodes on CT scanning. Clinicians should be more suspicious of a diagnosis of TB if the patient is a first generation immigrant or has failed to improve on anti-Crohn's treatment, although many of the latter will turn out to have idiopathic inflammatory bowel disease. For these patients, tissue diagnosis is indeed desirable, but it should be remembered that colonoscopic or laparoscopic biopsies may be inadequate. Tuberculin skin testing, chest radiographs and paracentesis are often unhelpful in differentiating Crohn's from abdominal tuberculosis. Bacteriological confirmation of TB may not always be possible. We therefore disagree with Dr Kapoor, and feel it is justifiable to give patients a trial of empirical antituberculous therapy when there is a high index of suspicion. Response to treatment is usually evident within two weeks.5 If no improvement occurs, then more invasive measures are indicated to aid diagnosis – probably in the form of a laparotomy." @default.
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- W4367481978 date "1997-10-01" @default.
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- W4367481978 title "Koch's or Crohn's – or something else?" @default.
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- W4367481978 doi "https://doi.org/10.1111/j.1742-1241.1997.tb11525.x" @default.
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