P3191 - Ileal Aspirates for Study: A Novel Sample for Diagnosis of Intestinal Tuberculosis

Award: Presidential Poster Award

Md. Shakhawat Hossain, MD¹, Maknun Nahar, MPH², Md. Makhsudul Alam, MD^1
1Rangpur Medical College, Rangpur, Rangpur, Bangladesh; ²Bangladesh Open University, Rangpur, Rangpur, Bangladesh

Introduction: Over recent few years, the incidence of tuberculosis and intestinal TB (ITB) has markedly raised due to population migration, MDR-TB, HIV infection, use of immunosuppressive agents and biologics. Over and under diagnosis are also common, especially in developing countries. As the terminal ileum is the most common site of ITB, Ileal aspirates can be collected by colonoscopy with better diagnostic yielding. This study was aimed to evaluate the efficacy of ileal aspirates as a novel sample in diagnosis of Intestinal Tuberculosis at a tertiary care hospital in Bangladesh.

Methods: This was a cross sectional analytical study performed over 01 year period. We have studied 200 suspected ITB patients with 04 different investigation tools; Ileal aspirates for Gene Xpert, Stool Gene Xpert, Endoscopic or surgical Biopsy for histopathology and Endoscopic or surgical Biopsy for Gene Xpert.(Table-I). ITB diagnosed patients were followed up for clinical improvement and treatment response for next two months. Finally 96 of them were diagnosed as confirmed ITB and104 were other diagnosis. The sensitivity, specificity, positive predictive value(PPV), and negative predictive value(NPV) and diagnostic accuracy of each test were calculated.

Results: Ileal aspirates showed 80.21%, 77.88%, 77.00% , 81.00% and 79.00% sensitivity, specificity, PPV, NPV and diagnostic accuracy respectively, which was quite better than other modalities. Performances of the other tools were given on Table-I.





Table I:

Suspected ITB patients(n=200)		Positive results		Negative results
		Finally Confirmed TB	Other Diagnosis	Finally confirmed TB	Other Diagnosis
Ileal aspirate Gene Xpert		77	23	19	81
Stool Gene Xpert		67	28	29	76
Colonoscopic/ surgical biopsy- HPR		41	32	55	72
Colonoscopic /surgical biopsy Gene Xpert		73	31	23	73
Diagnostic Tests (n=200)	Sensitivity(%)	Specificity(%)	PPV(%)	NPV(%)	Accuracy(%)
Ileal aspirate Gene Xpert	80.21	77.88	77.00	81.00	79.00
Stool Gene Xpert	69.79	73.08	70.53	72.38	71.50
Colonoscopic/ surgical biopsy- HPR	42.71	69.23	56.16	56.69	56.50
Colonoscopic /surgical biopsy Gene Xpert	76.04	70.19	70.19	76.04	73.00

Discussion: Diagnosis of ITB is challenging, especially where ITB and crohn’s disease both are common in community and can present simultaneusly.Ileal Aspirates can help better to detect bacteriological presence in intestine and thus we can confidently diagnose ITB with better differentiation from Crohn’s disease. This sample can be taken easily while on colonoscopy along with biopsy materials.


Disclosures:


Md. Shakhawat Hossain, MD¹, Maknun Nahar, MPH², Md. Makhsudul Alam, MD¹. P3191 - Ileal Aspirates for Study: A Novel Sample for Diagnosis of Intestinal Tuberculosis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.