The diagnosis of colonic tuberculosis is generally carried out by colonoscopy and targeted biopsy of lesions.
Despite this, colonic biopsies do not provide a highly accurate means of reaching a correct diagnosis.
Researchers from the Departments of Gastroenterology and Pathology at the Motilal Nehru Medical College in Allahabad, India, therefore set out to investigate the role of biopsies from endoscopically normal-appearing cecum and terminal ileum in diagnosing colonic or ileal tuberculosis, or both.
They studied 50 patients with a clinical suspicion of colonic tuberculosis, in whom no endoscopic abnormalities were found on colonoscopy or ileoscopy.
In each case, multiple biopsies were obtained from both the cecum and the ileum.
In a total of 43 of the 50 patients (86%) it was possible to carry out intubation of the terminal ileum.
In 2 patients, histological examination of biopsies obtained from the cecum and terminal ileum demonstrated non-caseating granuloma. In both these cases the biopsies were from the terminal ileum.
In 2 other patients, collections of loosely arranged epithelioid cells were observed. This established the diagnosis in these 4 patients (8 %).
In the remaining 46 patients, histology showed nonspecific inflammation in 18 patients (in the cecum in 15 and in the terminal ileum in seven).
The other biopsies did not show any abnormalities (33 from the cecum, 34 from the terminal ileum).
S. P. Misra, lead author of the study, said that it showed, "Histological examination of biopsies from the normal-appearing cecum and terminal ileum is useful in a small but significant number of patients with colonic tuberculosis."