Prospective evaluation of the clinical utility of interferon-γ assay in the differential diagnosis of intestinal tuberculosis and Crohn's disease

Beom Jin Kim, Yong Sung Choi, Byung Ik Jang, Young Sook Park, Won Ho Kim, You Sun Kim, Sung Ae Jung, Dong Soo Han, Joo Sung Kim, Jai Hyun Choi, Chang Hwan Choi, Yoon Tae Jeen, JaeHee Cheon, Byong Duk Ye, Suk Kyun Yang, Young Ho Kim

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Abstract

Background: Distinguishing intestinal tuberculosis (ITB) from Crohn's disease (CD) is challenging. This study prospectively evaluated the clinical utility of the QuantiFERON-TB gold test (QFT) in the differential diagnosis of ITB and CD, and compared it with the clinical utility of the tuberculin skin test (TST). Methods: Patients with suspected ITB or CD on colonoscopic findings were enrolled from 13 hospitals in Korea between June 2007 and November 2008. A QFT and TST were performed. When the initial diagnosis was not confirmed, 2-3 months of empiric antituberculous therapy was administered. Results: In all, 128 patients were analyzed; 64 patients had ITB and 64 patients had CD. The median age of patients with ITB was greater than the patients with CD (47 years versus 31 years, P < 0.001). The positive rate for the QFT and TST (≥10 mm) in patients with ITB was significantly higher than patients with CD (67% versus 9% and 69% versus 16%, respectively; P < 0.001). The QFT and TST had good agreement (Î = 0.724, P < 0.001). The diagnostic validity of QFT in ITB had a 67% sensitivity, 90% specificity, 87% positive predictive value, and 73% negative predictive value. There was no difference in these parameters between the QFT and TST. The likelihood ratio for a positive QFT was higher than a positive TST in the diagnosis of ITB (7.1 and 4.4, respectively). Conclusions: The QFT is a limited but useful diagnostic aid in combination with the TST in the diagnosis of ITB.

Original languageEnglish
Pages (from-to)1308-1313
Number of pages6
JournalInflammatory Bowel Diseases
Volume17
Issue number6
DOIs
Publication statusPublished - 2011 Jun 1

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Intestinal Diseases
Tuberculin Test
Crohn Disease
Interferons
Gold
Tuberculosis
Differential Diagnosis
Skin Tests
Korea
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Gastroenterology

Cite this

Kim, Beom Jin ; Choi, Yong Sung ; Jang, Byung Ik ; Park, Young Sook ; Kim, Won Ho ; Kim, You Sun ; Jung, Sung Ae ; Han, Dong Soo ; Kim, Joo Sung ; Choi, Jai Hyun ; Choi, Chang Hwan ; Jeen, Yoon Tae ; Cheon, JaeHee ; Ye, Byong Duk ; Yang, Suk Kyun ; Kim, Young Ho. / Prospective evaluation of the clinical utility of interferon-γ assay in the differential diagnosis of intestinal tuberculosis and Crohn's disease. In: Inflammatory Bowel Diseases. 2011 ; Vol. 17, No. 6. pp. 1308-1313.
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title = "Prospective evaluation of the clinical utility of interferon-γ assay in the differential diagnosis of intestinal tuberculosis and Crohn's disease",
abstract = "Background: Distinguishing intestinal tuberculosis (ITB) from Crohn's disease (CD) is challenging. This study prospectively evaluated the clinical utility of the QuantiFERON-TB gold test (QFT) in the differential diagnosis of ITB and CD, and compared it with the clinical utility of the tuberculin skin test (TST). Methods: Patients with suspected ITB or CD on colonoscopic findings were enrolled from 13 hospitals in Korea between June 2007 and November 2008. A QFT and TST were performed. When the initial diagnosis was not confirmed, 2-3 months of empiric antituberculous therapy was administered. Results: In all, 128 patients were analyzed; 64 patients had ITB and 64 patients had CD. The median age of patients with ITB was greater than the patients with CD (47 years versus 31 years, P < 0.001). The positive rate for the QFT and TST (≥10 mm) in patients with ITB was significantly higher than patients with CD (67{\%} versus 9{\%} and 69{\%} versus 16{\%}, respectively; P < 0.001). The QFT and TST had good agreement ({\^I} = 0.724, P < 0.001). The diagnostic validity of QFT in ITB had a 67{\%} sensitivity, 90{\%} specificity, 87{\%} positive predictive value, and 73{\%} negative predictive value. There was no difference in these parameters between the QFT and TST. The likelihood ratio for a positive QFT was higher than a positive TST in the diagnosis of ITB (7.1 and 4.4, respectively). Conclusions: The QFT is a limited but useful diagnostic aid in combination with the TST in the diagnosis of ITB.",
author = "Kim, {Beom Jin} and Choi, {Yong Sung} and Jang, {Byung Ik} and Park, {Young Sook} and Kim, {Won Ho} and Kim, {You Sun} and Jung, {Sung Ae} and Han, {Dong Soo} and Kim, {Joo Sung} and Choi, {Jai Hyun} and Choi, {Chang Hwan} and Jeen, {Yoon Tae} and JaeHee Cheon and Ye, {Byong Duk} and Yang, {Suk Kyun} and Kim, {Young Ho}",
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Kim, BJ, Choi, YS, Jang, BI, Park, YS, Kim, WH, Kim, YS, Jung, SA, Han, DS, Kim, JS, Choi, JH, Choi, CH, Jeen, YT, Cheon, J, Ye, BD, Yang, SK & Kim, YH 2011, 'Prospective evaluation of the clinical utility of interferon-γ assay in the differential diagnosis of intestinal tuberculosis and Crohn's disease', Inflammatory Bowel Diseases, vol. 17, no. 6, pp. 1308-1313. https://doi.org/10.1002/ibd.21490

Prospective evaluation of the clinical utility of interferon-γ assay in the differential diagnosis of intestinal tuberculosis and Crohn's disease. / Kim, Beom Jin; Choi, Yong Sung; Jang, Byung Ik; Park, Young Sook; Kim, Won Ho; Kim, You Sun; Jung, Sung Ae; Han, Dong Soo; Kim, Joo Sung; Choi, Jai Hyun; Choi, Chang Hwan; Jeen, Yoon Tae; Cheon, JaeHee; Ye, Byong Duk; Yang, Suk Kyun; Kim, Young Ho.

In: Inflammatory Bowel Diseases, Vol. 17, No. 6, 01.06.2011, p. 1308-1313.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prospective evaluation of the clinical utility of interferon-γ assay in the differential diagnosis of intestinal tuberculosis and Crohn's disease

AU - Kim, Beom Jin

AU - Choi, Yong Sung

AU - Jang, Byung Ik

AU - Park, Young Sook

AU - Kim, Won Ho

AU - Kim, You Sun

AU - Jung, Sung Ae

AU - Han, Dong Soo

AU - Kim, Joo Sung

AU - Choi, Jai Hyun

AU - Choi, Chang Hwan

AU - Jeen, Yoon Tae

AU - Cheon, JaeHee

AU - Ye, Byong Duk

AU - Yang, Suk Kyun

AU - Kim, Young Ho

PY - 2011/6/1

Y1 - 2011/6/1

N2 - Background: Distinguishing intestinal tuberculosis (ITB) from Crohn's disease (CD) is challenging. This study prospectively evaluated the clinical utility of the QuantiFERON-TB gold test (QFT) in the differential diagnosis of ITB and CD, and compared it with the clinical utility of the tuberculin skin test (TST). Methods: Patients with suspected ITB or CD on colonoscopic findings were enrolled from 13 hospitals in Korea between June 2007 and November 2008. A QFT and TST were performed. When the initial diagnosis was not confirmed, 2-3 months of empiric antituberculous therapy was administered. Results: In all, 128 patients were analyzed; 64 patients had ITB and 64 patients had CD. The median age of patients with ITB was greater than the patients with CD (47 years versus 31 years, P < 0.001). The positive rate for the QFT and TST (≥10 mm) in patients with ITB was significantly higher than patients with CD (67% versus 9% and 69% versus 16%, respectively; P < 0.001). The QFT and TST had good agreement (Î = 0.724, P < 0.001). The diagnostic validity of QFT in ITB had a 67% sensitivity, 90% specificity, 87% positive predictive value, and 73% negative predictive value. There was no difference in these parameters between the QFT and TST. The likelihood ratio for a positive QFT was higher than a positive TST in the diagnosis of ITB (7.1 and 4.4, respectively). Conclusions: The QFT is a limited but useful diagnostic aid in combination with the TST in the diagnosis of ITB.

AB - Background: Distinguishing intestinal tuberculosis (ITB) from Crohn's disease (CD) is challenging. This study prospectively evaluated the clinical utility of the QuantiFERON-TB gold test (QFT) in the differential diagnosis of ITB and CD, and compared it with the clinical utility of the tuberculin skin test (TST). Methods: Patients with suspected ITB or CD on colonoscopic findings were enrolled from 13 hospitals in Korea between June 2007 and November 2008. A QFT and TST were performed. When the initial diagnosis was not confirmed, 2-3 months of empiric antituberculous therapy was administered. Results: In all, 128 patients were analyzed; 64 patients had ITB and 64 patients had CD. The median age of patients with ITB was greater than the patients with CD (47 years versus 31 years, P < 0.001). The positive rate for the QFT and TST (≥10 mm) in patients with ITB was significantly higher than patients with CD (67% versus 9% and 69% versus 16%, respectively; P < 0.001). The QFT and TST had good agreement (Î = 0.724, P < 0.001). The diagnostic validity of QFT in ITB had a 67% sensitivity, 90% specificity, 87% positive predictive value, and 73% negative predictive value. There was no difference in these parameters between the QFT and TST. The likelihood ratio for a positive QFT was higher than a positive TST in the diagnosis of ITB (7.1 and 4.4, respectively). Conclusions: The QFT is a limited but useful diagnostic aid in combination with the TST in the diagnosis of ITB.

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U2 - 10.1002/ibd.21490

DO - 10.1002/ibd.21490

M3 - Article

VL - 17

SP - 1308

EP - 1313

JO - Inflammatory Bowel Diseases

JF - Inflammatory Bowel Diseases

SN - 1078-0998

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