Which one of the following is the most accurate statement concerning gastrointestinal tuberculosis?

Malabsorption is a Recognized Complication of Gastrointestinal Tuberculosis

Malabsorption is indeed a recognized complication of gastrointestinal tuberculosis, particularly when there is extensive small bowel involvement or stricture formation 1.

Clinical Features and Pathophysiology of Gastrointestinal TB

Gastrointestinal tuberculosis (GITB) can affect any part of the digestive tract, with the following key characteristics:

Anatomical Distribution

• The ileocecal region is the most common site of involvement (not the ascending colon) 1, 2
• Approximately 84% of patients have ileocecal valve involvement 3
• The infection can spread to involve the peritoneum, hollow or solid abdominal organs, and abdominal lymphatics 2

Relationship with Pulmonary TB

• Less than 25% of patients with gastrointestinal TB have concomitant active pulmonary tuberculosis 1, 4
• This contradicts the statement that "80% of those with intestinal TB have pulmonary involvement"

Pathological Features

• GITB can cause transverse ulcers, fibrosis, thickening and stricturing of the bowel wall 1
• Pseudopolyps can occur in intestinal TB, making the statement "It does not cause pseudopolyps in the intestine" incorrect 5
• Other findings include enlarged mesenteric lymph nodes, omental thickening, and peritoneal tubercles 1

Complications of Gastrointestinal TB

Several complications can occur with gastrointestinal tuberculosis:

• Malabsorption: Occurs especially in the presence of strictures or extensive small bowel involvement 1
• Intestinal obstruction due to stricture formation
• Perforation
• Fistula formation
• Gastrointestinal bleeding

Diagnosis of Gastrointestinal TB

Diagnosis often requires a combination of approaches:

• Radiologic studies (barium studies, CT scan, ultrasonography)
• Endoscopic evaluation with biopsy
• Laparoscopy with directed biopsy for peritoneal involvement
• Microbiological testing:
  • TB PCR on intestinal biopsies (73.83% accuracy) 3
  • BACTEC-MGIT culture (100% specificity but only 20.29% sensitivity) 3
  • Histological detection of granulomas (78.95% specificity, 36.23% sensitivity) 3

Treatment and Outcomes

• Standard anti-TB therapy is effective for gastrointestinal tuberculosis 2, 6
• The recommended duration is at least 6 months 1, 5
• The statement that "Cure with standard anti-TB therapy is rare" is incorrect
• Treatment consists of:
  • Initial phase: 2 months of isoniazid, rifampin, pyrazinamide, and ethambutol 5
  • Continuation phase: 4 months of isoniazid and rifampin 5
• Surgery is occasionally required for complications such as obstruction, perforation, or diagnostic uncertainty 2, 4

Differential Diagnosis

Gastrointestinal TB must be differentiated from:

• Crohn's disease (particularly challenging in regions where both conditions are prevalent) 3
• Malignancy
• Other infectious colitis

The British Society of Gastroenterology recommends that tuberculosis should be considered in patients with suspected ileocecal Crohn's disease, particularly in patients from endemic areas or with other risk factors for infection 5.

In conclusion, among the statements presented, "Malabsorption is a recognized complication" is the most accurate statement concerning gastrointestinal tuberculosis.