The Establishment Of A New Method For The Differential Diagnosis Of Crohn’s Disease

BackgroundCrohn’s disease (CD) is charicterised by an unknown etiology and chronic nonspecific inflammation of the bowel.Its clinical manifestations are complicated and a definite diagnosis is difficult so that the misdiagnosis rate is higher.The outcome of treatment of CD is often poor. There are two major reasons for the difficulty in diagnosis of CD:one is the lack of gold standard of diagnosis such as histology or serology; the second is complicity of the differential diagnosis. Especially difficult is the differentiation of CD with intestinal tuberculosis.AimsTo establish a scoring system to help the differential diagnosis of crohn’s disease and improvecorrect diagnostic rateof Crohn’s disease.MethodsThe clinical characteristics of CD and ITBwere retrospectively analysed and summarized.according to the frequency of their occurrence. A scoring system was established for differential diagnosis of CD and then prospectively verified by a new cohort of patients for the effectiveness of the scoring system to diagnose CD.. ResultsThrough a retrospective case analysis, the clinical characteristics in high frequency were documented for patients with CD such as intestinal fistula (specificity100%), extraintestinal manifestation (specificity100%),parianal lesions (specificity100%), longitudinal ulcer (specificity100%), cobblestone appearance (specificity100%), hi story of intestinal disection (specificity98.1%), bloody diarrhea(specificity94.9%); For ITB patients, such as active tuberculosis(specificity100%), tuberculous peritonitis (specificity100%), T-SPOT positive (specificity98.5%), night sweats(specificity97.5%), ascites (specificity98.7%), circumferential ulcers (specificity97.5%). A scoring system was establishedaccording to the above specificity in order to improve differential diagnosis between CD and ITB:diagnostic score=1x bloody diarrhea+3x perianal lesions+3x intestinal fistula+3x longitudinal ulcer+3x extraintestinal manifestation+3x cobblestone appearance+2x history of intestinal dissection+(-2x night sweats)+(3x active tuberculosis)+(3x tuberculous peritonitis)+(-2x ascites)+(-2x T-spot positive)+(-2x circumferential ulcer). For the validation study,149CD patients and72ITB patients were prospectively observed by using the differential diagnosis discriminant.The results showedThe sensitivity and specificiity of the scoring system in differential diagnosis of CD were83.8%and96.2%respectively; The sensitivity and specificity of ITB were80.5%and98.9%respectively; Other related disease’s diagnosis sensitivity is low, lymphoma (8%), Behcet disease (10%)ConclusionsCD has clinical features to identify. Clinical characteristics-based scoring system for the differential diagnosis of CD showed clinical significance, but the real clinical value needs further multicenter prospective study to prove.