Foregut tuberculosis: Too close but miles apart

Table 1 Esophageal tuberculosis

Ref.	Age, sex	Presentation	Diagnosis and treatment
Diallo et al[11]	58-year-old man	Dysphagia for 3 months with non-quantified weight loss, anorexia and fever	Esophageal biopsy showed caseous granuloma. Treated with ATT
Mao et al[12]	27-year-old woman	1-month history of progressive dysphagia, accompanied by post-sternal pain, belching, acid regurgitation, heartburn, and nausea	Esophageal endoscopy with biopsy performed showed interstitial granulation tissue. TB PCR was positive. Treated with ATT
Savage et al[13]	46-year-old woman	6-week history of dysphagia and retrosternal chest pain unrelieved by antacids	Barium swallow showed a 10 cm plaque-like mid-esophageal lesion. Biopsies taken during esophagoscopy were inconclusive. Repeat biopsy 1 month later demonstrated caseating granulomata in the submucosa. Treated with ATT
Savage et al[13]	26-year-old man	6-week history of dysphagia for solids and retrosternal pain	Barium meal: Extrinsic compression in the mid-esophagus. Chest X ray: Sub carinal lymphadenopathy; Mantoux test: Strongly positive at 1:10000; Endoscopic biopsies were non-specific. A diagnosis of esophageal TB was made on radiological appearances and strongly positive Mantoux test. Treated with ATT
Han et al[15]	56-year-old woman	2-week history of mild dysphagia	Esophageal biopsies showed numerous epithelioid caseating granulomas. The PPD skin test, T-SPOT. TB assay and polymerase chain reaction testing for MTB were positive. Treated with ATT
Jain et al[17]	15-year-old man	Bouts of hematemesis and melena for 2 days	EGD followed with biopsy revealed caseating epithelioid granulomas with lymphocytic infiltrate. PCR positive for TB. Treated with ATT
Khan et al[18]	25-year-old man	1-month progressive dysphagia for both solids and liquids associated with epigastric pain	Endoscopy followed with biopsy showed granulation tissue. Cultures of biopsied tissue were positive for MTB PCR was positive. Treated with ATT
Zahra et al[22]	27-year-old man	Burning chest pain for 3 months; Intermittent fever, weight loss, loss of appetite for few weeks	EGD followed by biopsy revealed granulomatous caseating lesion. Nucleic acid amplification test was positive for TB. Treated with ATT
Abid et al[23]	45-year-old woman	Progressive dysphagia and weight loss (8 kg) for 6 months	Endoscopic biopsy of esophageal ulcers revealed granulomatous changes. AFB staining and MTB complex PCR was negative. Treated with ATT
Abid et al[23]	80-year-old woman	Massive hematemesis without any history of dysphagia, odynophagia, regurgitation	Endoscopy showed multiple ulcers in proximal esophagus, biopsy of which received granulomatous lesions. AFB stain for MTB was negative, but a positive PCR. Patient died next day because of massive hematemesis
Abid et al[23]	85-year-old woman	Dysphagia and cough. 5 kg weight loss in 2 months	Endoscopic biopsy of a hyperemic patch in esophagus revealed granulomatous changes. AFB stain and PCR for MTB was negative. Patient died 3 days after hospitalization due to aspiration pneumonia
Abid et al[23]	29-year-old man	Odynophagia and retrosternal burning	Endoscopic biopsy of esophageal ulcer revealed positive MTB PCR, although cultures showed no growth. Treated with ATT
Mohan et al[24]	30-year-old woman	Fever, malaise and decreased appetite for 3 weeks. She had dysphagia and cough during swallowing for 4 days	Chest X ray: Miliary TB. Upper GI endoscopy showed ulcer, biopsy of which revealed chronic inflammation with granuloma. Treated with ATT
Olson et al[25]	35-year-old man	2 months of progressive dysphagia and odynophagia	AFB culture positive for MTB from surgically removed mediastinal lymph node. Treated with ATT
Fujiwara et al[26]	82-year-old man	Progressive dysphagia	Esophagoscopy with biopsy showed epithelioid granulation. CT chest showed enlarged sub carinal lymph nodes. Responded to ATT
Hu et al[27]	75-year-old man	Progressive dysphagia for 1 month	EUS followed by histopathology showed tuberculoid granuloma. PPD skin test and TB spot both were positive
Mahmoudi et al[28]	55-year-old woman	Progressive dysphagia for 3 months, weight loss, loss of appetite, intermittent fever	EGD followed by histopathological examination revealed epithelioid cell granulomas without caseous necrosis. Sputum examination for acid-fast bacilli was positive. Treated with ATT
Salad et al[29]	23-year-old man	Cough on eating and halitosis, mild weight loss	EGD followed with biopsy showed inflammatory lesions with epithelioid granulomas. Treated with ATT
Khanna et al[30]	60-year-old man	Progressive dysphagia for 4 months with loss of weight and appetite	Endoscopy followed by biopsy showed epithelioid granulomas with caseating necrosis. TB PCR was positive. Treated with ATT
Danna et al[31]	69-year-old man	Persistent fever and dysphagia for 4 weeks	EGD followed showed deep esophageal ulcerations followed with biopsy with special stains positive for AFB. Treated with ATT
Baleguli et al[32]	24-year-old woman	1 month of dysphagia and odynophagia associated with low-grade fevers, dry cough, night sweats, anorexia, sore throat, and pound weight loss	EGD followed with esophageal biopsies showed active ulcerative and granulomatous esophagitis with mycobacterial organisms. AFB culture grew MTB and MTB PCR was positive. Treated with ATT

AFB: Acid-fast bacilli; ATT: Anti-tuberculosis therapy; EGD: Esophagogastroduodenoscopy; EUS: Endoscopic ultrasonography; GI: Gastrointestinal; MTB: Mycobacterium tuberculosis; PPD: Purified protein derivative; TB: Tuberculosis; PCR: Polymerase chain reaction.

Table 2 Gastric tuberculosis

Ref.	Age, sex	Presentation	Diagnosis and treatment
Eray et al[40]	42-year-old woman	Loss of appetite, post-prandial epigastric pain, weight loss	Post- operation (on prediagnosis of gastric cancer) biopsy of tissue showed caseating granulomatous inflammation. TB PCR was positive. Treated with ATT
Zhu et al[41]	25-year-old woman	Upper abdominal discomfort and distension	EUS along with biopsy revealed granulomatous inflammation. PPD skin test was positive. Treated with ATT for 1 year
Zhu et al[41]	52-year-old woman	Upper abdominal pain and swelling for 6 months, 3 kg weight loss over 2 months, low-grade fever and night sweats for 1 week	EUS followed with biopsy showed granulomatous inflammation with caseous necrosis. Treated with ATT for 13 months
Zhu et al[41]	16-year-old man	Upper abdominal pain and fatigue for 3 months along with 4 kg weight loss	Biopsy post ESD (done with suspected diagnosis of interstitial tumor) showed caseous granuloma. PPD skin test was positive. Treated with ATT for 6 months
Seetlani et al[43]	55-year-old man	Persistent episodes of nonbilious vomiting and epigastric pain for 3 months, associated with weight loss	Endoscopic biopsies showed epithelioid cell granulomas. Multiple solid enhancing lymph nodes were seen on CT Abdomen. Treated with ATT for 6 months
Lv et al[44]	60-year-old woman	Endoscopy from another hospital showed smooth protruding lesion from gastric cardia	ESD performed (due to suspicion of gastric stromal tumor) followed with biopsy showed caseous necrosis. TB PCR was positive. Treated with ATT
Yan et al[45]	53-year-old woman	Upper abdominal pain and discomfort for 4 years	Histological analysis post laparoscopic surgical resection (due to suspected gastric tumor) showed granulomatous inflammation. GeneXpert MTB was positive
Lim et al[46]	38-year-old woman	Epigastric discomfort for 1 month along with palpable abdominal mass	Endoscopic biopsy showed necrotic granuloma with an abscess. AFB stain and PCR were positive for MTB. Due to resistance kanamycin, moxifloxacin, prothionamide and cycloserin and pyrazinamide were given for 1 year
Ma et al[47]	26-year-old woman	Constant gastric pain for 1 month accompanied with acid reflux	Gastroscopic biopsy showed caseous granuloma. MTB PCR was positive. Treated with ATT for 18 months
Talukdar et al[48]	30-year-old woman	Epigastric pain for 1 year along with progressive loss of appetite and 15 kg weight loss	Thickened gastric wall on CT scan. Endoscopic biopsy showed epithelioid granuloma with caseation. Ziehl–Nielsen staining of the biopsy specimen revealed AFB
Manoria et al[49]	39-year-old woman	Epigastric pain for 1 month accompanied with 3 kg weight loss	Endoscopic biopsy revealed multiple granulomas with epithelioid cells and multinucleate cells. Mantoux test was positive. Treated with ATT
Sharma et al[50]	21-year-old woman	2-day history of acute abdominal pain with bouts of hematemesis. CT showed gastric perforation	Biopsy post emergency distal gastrectomy revealed tuberculosis granulation tissue and acid- fast bacilli in the ulcer
Zhang et al[51]	40-year-old woman	Painful enlarged cervical lymph nodes for 2 weeks	Gastroscopic biopsy showed chronic granulomatous inflammation. AFB was positive. Treated with ATT for 6 months
Liu et al[52]	68-year-old man	Epigastric pain for a few months	Subtotal gastrectomy (suspected tumor) followed by histopathological examination revealed necrotizing granulomatous inflammation. MTB PCR was positive
Liu et al[53]	52-year-old woman	Upper abdominal pain for 6 months	Endoscopic biopsy showed caseous granuloma. Acid-fast stain and MTB PCR were positive
Khan et al[54]	29-year-old man	Epigastric pain for 1 month with 7 kg weight loss	Endoscopic biopsy specimen revealed caseating granulomas with AFB. Positive cultures for MTB

AFB: Acid-fast bacilli; ATT: Anti-tuberculosis therapy; CT: Computed tomography; EGD: esophagogastroduodenoscopy; ESD: Endoscopic submucosal dissection; MTB: Mycobacterium tuberculosis PCR: Polymerase chain reaction; PPD: Purified protein derivative.

Table 3 Duodenal tuberculosis

Ref.	Age, sex	Presentation	Diagnosis and treatment
Mani and Rananavare[56]	18-year-old man	Persistent vomiting due to duodenal stricture as shown in endoscopy	Underwent laparotomy and resection. Post-surgical specimen revealed tuberculosis granulomas
De et al[57]	38-year-old woman	Recurrent vomiting	CT showed mural thickening of duodenum, deeper endoscopic biopsies revealed non-necrotizing granulomata. Treated with ATT
Naouri et al[58]	69-year-old man	Duodenal stenosis	Misdiagnosed as Crohn’s disease
Sato et al[60]	35-year-old man	Abdominal fullness, vomiting, CT showed the duodenal wall thickening, luminal narrowing, multiple enlarged abdominal lymph node	EUS-FNA biopsy of duodenum showed caseating granulomas with multinucleated giant cells, and AFB were positive by Ziehl–Nielsen staining. Underwent laparoscopic gastrojejunostomy, and ATT after surgery
Antón Rodríguez et al[61]	60-year-old woman	Weight loss, bloating, duodenal thickening on CT scan	Endoscopic biopsy showed granulomatous inflammation and positive PCR for MTB. Treated with ATT
Chang et al[62]	52-year-old man	Early satiety, post meal abdominal pain, weight loss	Duodenal tissue culture showed growth of MTB. Treated with ATT
Pratap et al[63]	43-year-old woman	Nausea, vomiting, fever, weight loss	Duodenal ulcer on endoscopy with biopsy showing active duodenitis and positive AFB stain, lymph node biopsy also confirmed TB. Treated with ATT
Dahiya et al[64]	23-year-old man	Post-prandial fullness, weight loss	Duodenal narrowing on endoscopy. Duodenal segment resection with duodenojejunostomy, biopsy showed granulomatous inflammation suggestive of TB
Zhang et al[65]	71-year-old man	Upper abdominal pain	Space occupying lesion on CT scan, endoscopic biopsy showed granulomas. Treated with ATT
Moirangthem et al[66]	17-year-old man	Gastric outlet obstruction	Underwent laparotomy which revealed duodenal mass. Biopsy showed caseating tuberculosis
Berney et al[67]	22-year-old man	Duodenal ulcer perforation	Underwent laparotomy. Margins of ulcer were resected. Biopsy showed giant-cell-granulomatous inflammation. Lymph node biopsy showed caseating necrosis
Souhaib et al[68]	33-year-old woman	Perforated duodenal ulcer which was initially diagnosed as acute cholecystitis	Underwent laparotomy. Peri-duodenal lymph node and the gallbladder lymph node showed caseating necrosis
Sharma et al[69]	32-year-old man	Recurrent vomiting, weight loss, thickened duodenum seen on CT scan and endoscopy	Histopathology revealed features of chronic inflammation, giant cells, and granulomas. Ziehl–Nielsen stain of tissue specimens was positive for AFB. Treated with ATT for 8 months

AFB: Acid-fast bacilli; ATT: Anti-tuberculosis therapy; CT: Computed tomography; EUS: Endoscopic ultrasound; FNA: Fine needle aspirate; MTB: Mycobacterium tuberculosis; PCR: Polymerase chain reaction.