Distinguishing tuberculosis and Crohn's disease in developing countries: How certain can you be of the diagnosis?

Distinguishing tuberculosis and Crohn's disease in patients presenting with chronic abdominal pain and diarrhea is a huge diagnostic challenge, particularly in tuberculosis endemic countries. A large number of patients with Crohn's disease are initially misclassified as having Intestinal tuberculosis in places where tuberculosis is endemic before they are treated for Crohn's disease. Although a variety of endoscopic, radiological and histological criteria have been recommended for the differentiation, it often proves difficult in routine clinical practice. Future prospective studies are required in patients with granulomatous colitis to prevent unnecessary inappropriate anti tuberculous therapy for patients with Crohn's disease and appropriate early treatment for a patient with tuberculosis.