Intestinal tuberculosis (ITB), a subset of extrapulmonary tuberculosis (EPTB), arises from Mycobacterium tuberculosis infection, primarily affecting the ileocecal region due to its lymphatic tissue richness. Representing approximately 10% of global EPTB cases, ITB is most prevalent in regions with high tuberculosis (TB) incidence. Its nonspecific symptoms—abdominal pain, diarrhea, fever, and weight loss—pose significant diagnostic challenges and frequently overlap with conditions like Crohn’s disease (CD). This diagnostic complexity is compounded by shared clinical, endoscopic, and histological features, with misdiagnosis risking inappropriate immunosuppressive therapy that exacerbates TB progression. Diagnostic tools include endoscopy with biopsy, imaging modalities (CT, MRI, ultrasound), and molecular assays like GeneXpert for rapid detection and drug resistance assessment. While histological markers such as caseating granulomas aid differentiation, advanced molecular methods enhance diagnostic precision. Emerging technologies, including next-generation sequencing, CRISPR-based diagnostics, and artificial intelligence in imaging, show promise in addressing diagnostic gaps. However, resource-limited settings face significant barriers, relying on less sensitive conventional methods. Integrated approaches combining clinical, histopathological, and molecular evaluations are essential for accurate diagnosis and effective management. Strengthening healthcare infrastructure, expanding access to advanced diagnostics, and leveraging innovative technologies are critical for reducing ITB-related morbidity and mortality. Keywords: Intestinal tuberculosis, Diagnostic challenges, Molecular diagnostics, Artificial intelligence, GeneXpert.

Tadikonda Rama Rao

Afshaan Tabassum

Challenging Diagnosis of Intestinal Tuberculosis: A Review

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