Published online Sep 14, 2017. doi: 10.3748/wjg.v23.i34.6306
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
To investigate the temporal trends in the misdiagnosis rate between Crohn’s disease (CD) and intestinal tuberculosis (ITB) in South Korea.
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.
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.
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.