Copyright
©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Temporal trends in the misdiagnosis rates between Crohn’s disease and intestinal tuberculosis
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
Hyungil Seo, Hoonsub So, Donghoi Kim, 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 Medicine, Asan Medical Center, Seoul 05505, South Korea
Seohyun Lee, Division of Gastroenterology, Department of Internal Medicine, Center for Health Promotion, Seoul National University Hospital, Seoul 03080, South Korea
Seon-Ok Kim, Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
Jae Seung Soh, Division of Gastroenterology, Department of Internal Medicine, Hallym University College of Medicine Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do 14068, South Korea
Jung Ho Bae, Department of Gastroenterology, Seoul National University College of Medicine, Seoul National University Hospital Gangnam Center, Seoul 06236, South Korea
Sung Wook Hwang, Sang Hyoung Park, Kyung-Jo Kim, Suk-Kyun Yang, Byong Duk Ye, Inflammatory Bowel Disease Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
Author contributions: Seo H and Lee S contributed equally to this work; Ye BD contributed to study conception and design; Seo H, Lee S, So H, Kim D, Soh JS, Bae JH, and Ye BD contributed to data collection; Seo H, Lee S, Kim SO, and Ye BD contributed to data analysis and interpretation; Seo H and Lee S drafted the manuscript; Seo H, Lee SH, and Ye BD revised the manuscript; Hwang SW, Park SH, Yang DH, Kim KJ, Ye BD, Byeon JS, Myung SJ, and Yang SK cared for the patients, contributed to data acquisition, and critically reviewed the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the institutional review boards of Asan Medical Center (Seoul, south Korea; IRB No. 2010-0882).
Informed consent statement: Patients were not required to give informed consent to the study. We retrospectively reviewed anonymized clinical data after each patient received standard management. Individuals cannot be identified based on the data presented.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Byong Duk Ye, MD, PhD, Department of Gastroenterology, Inflammatory Bowel Disease Center, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
bdye@amc.seoul.kr
Telephone: +82-2-30103181 Fax: +82-2-4760824
Received: June 8, 2017
Peer-review started: June 8, 2017
First decision: July 10, 2017
Revised: July 30, 2017
Accepted: August 15, 2017
Article in press: August 15, 2017
Published online: September 14, 2017
Processing time: 98 Days and 13 Hours
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 group.
RESULTS
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.
Core tip: In South Korea, tuberculosis (TB) is still prevalent, but its incidence has been decreasing. On the other hand, the incidence and prevalence of Crohn’s disease (CD) has been increasing as in many Asian countries. In this paper, we demonstrated inverse trends in the misdiagnosis rates between CD and intestinal TB (ITB) over the last two decades. That is, cases of CD misdiagnosed initially as ITB have been decreasing, whereas cases of ITB misdiagnosed initially as CD has been increasing. More attention is needed for the correct diagnosis of CD or ITB, which could improve patients’ outcomes with proper management.
