Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2016; 4(8): 207-212
Published online Aug 16, 2016. doi: 10.12998/wjcc.v4.i8.207
Abdominal tuberculosis: Diagnosis and demographics, a 10-year retrospective review from a single centre
Jeremy S Nayagam, Claire Mullender, Catherine Cosgrove, Andrew Poullis
Jeremy S Nayagam, Andrew Poullis, Gastroenterology, St George’s Hospital, London SW17 0QT, United Kingdom
Claire Mullender, Catherine Cosgrove, Clinical Infection Unit, St George’s Hospital, London SW17 0QT, United Kingdom
Author contributions: Nayagam JS wrote the manuscript; Nayagam JS and Mullender C collected and analysed the data; Nayagam JS, Cosgrove C and Poullis A convened the idea; Mullender C drafted the manuscript; Cosgrove C edited the manuscript; Cosgrove C and Poullis A supervised the project; Poullis A finalised the manuscript in its current version.
Institutional review board statement: In line with national guidelines in the United Kingdom ethics committee approval is not required for this type of study (as a retrospective analysis of a previously investigated clinical cohort) according to the United Kingdom National Research Ethics Service.
Conflict-of-interest statement: No potential conflict of interest; no financial support.
Data sharing statement: Dataset is available from the corresponding author. Consent was not obtained but the presented data are anonymized and risk of identification is low.
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:
Correspondence to: Dr. Andrew Poullis, Gastroenterology, St George’s Hospital, Blackshaw Road, London SW17 0QT, United Kingdom.
Telephone: +44-208-6721255 Fax: +44-208-7253520
Received: March 15, 2016
Peer-review started: March 18, 2016
First decision: April 18, 2016
Revised: April 28, 2016
Accepted: June 14, 2016
Article in press: June 16, 2016
Published online: August 16, 2016

AIM: To review all cases of abdominal tuberculosis (ATB) for demographic details, diagnostic work up and evidence of vitamin D deficiency.

METHODS: This was a retrospective analysis of all patients diagnosed with ATB from June 2003 to August 2013 at St George’s Hospital, London. Demographic data was available from the local tuberculosis database. Further clinical information was collected from electronic patient records, including radiology, endoscopy, microbiology, histology, biochemistry and serology. Patients were classified as either confirmed ATB [if mycobacteria tuberculosis (MTB) was cultured from abdominal site] or presumed ATB (if suggestive findings or high clinical suspicion). Subtypes of ATB were classified as tuberculosis (TB) peritonitis, luminal TB, solid organ TB or from a combination of sites.

RESULTS: There were a total of 65 cases identified in this time period, with a mean of 6.5 cases per year (range 4-9). Mean age 42 years, 49.2% females. Fifty-two point three percent were South Asian, 38.5% African. Forty-nine point two percent had gastrointestinal endoscopy, 30.8% paracentesis and 24.6% surgery in order to obtain samples. Forty-seven point seven percent were defined as confirmed ATB with positive culture of MTB from abdominal sites, the rest were treated as presumed ATB. Twenty-four point six percent had co-existing sputum culture positive for MTB, and 30.8% had an abnormal chest X-ray. Subtypes of ATB: 35.4% had TB peritonitis; 27.7% luminal TB; 3.1% solid organ TB; and 33.8% TB at a combination of abdominal sites. Thirteen point nine percent were human immunodeficiency virus positive, all with CD4 count less than 300 cells/μL. Seventy point five percent had severe vitamin D deficiency, and 25% were vitamin D deficient.

CONCLUSION: ATB mainly affects young South Asian and African patients, with difficulties in confirming diagnosis despite a range of non-invasive and invasive diagnostic tests.

Keywords: Abdominal, Gastrointestinal, Tuberculosis, Vitamin D, Human immunodeficiency virus

Core tip: This is a single centre retrospective study of all cases of abdominal tuberculosis (ATB) from a single centre in the developed world. ATB remains a rare condition in the United Kingdom, which mainly occurs in young South Asians and African patients, and remains difficult to diagnose. When suspected, endoscopic biopsies must be taken in normal saline for microbiological assessment to help confirm the diagnosis. Chest radiology and sputum analysis should be performed as nearly a quarter had co-existent pulmonary tuberculosis. Vitamin D deficiency is common, and often severe, in ATB. Patients with human immunodeficiency virus and ATB present with low CD4 counts.