Intestinal Tuberculosis Diagnostics and the Differentiation From Crohn's Disease

NCT ID: NCT01503099

Last Updated: 2012-01-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

550 participants

Study Classification

OBSERVATIONAL

Study Start Date

2009-10-31

Study Completion Date

2012-12-31

Brief Summary

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One aims to devise a method for the screening and differentiation of intestinal tuberculosis and Crohn's Disease. Additionally, one aims to detect and survey multidrug resistant TB.

Detailed Description

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Intestinal tuberculosis (ITB) and Crohn's disease (CD) may present identically; the consequence of misdiagnosing and mistreating one disease for the other may be grave. CD is on the increase worldwide while TB re-emerges in areas of low TB endemicity. Current diagnostic guidelines evolve from research in areas with low TB prevalence, thereby being inappropriate in TB endemic regions. To date, no simple or non-invasive methods exist to diagnose ITB and to differentiate it from CD.

One aims to devise a method for screening and differentiation of the two diseases. By using non-invasive rapid tests one wishes to make diagnostics available to resource poor settings. Ideally, referrals to invasive diagnostic procedures would decrease, thus liberating economic and staff resources. Furthermore, patients may avoid unnecessary, expensive and often inconclusive advanced procedures. Additionally, one aims to detect and survey multidrug resistance caused by empiric TB treatment, which in itself obscures ITB diagnosis.

This case control study matches 50 ITB patients and 50 CD patients with 100 healthy controls in India, and 50 CD patients with 100 healthy controls in Norway. Comparative statistical analysis will be carried out. Challenges include patient adherence and sample handling. Non-TB gastrointestinal infections may confound the results and will be adjusted for.

Recently published data suggests that the serum/faecal calprotectin ratio may be used to discriminate ITB from healthy subjects.

Conditions

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Intestinal Tuberculosis Pulmonary Tuberculosis Crohn's Disease

Study Design

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Observational Model Type

CASE_CONTROL

Study Time Perspective

PROSPECTIVE

Study Groups

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Active ITB

Patients with active intestinal tuberculosis (ITB)

No interventions assigned to this group

Controls India

Healthy subjects serving as controls

No interventions assigned to this group

CD India

Patients with active Crohn's Disease (CD) in India

No interventions assigned to this group

Active PTB

Patients with active pulmonary tuberculosis (PTB)

No interventions assigned to this group

CD Norway

Patients with active Crohn's Disease (CD) in Norway

No interventions assigned to this group

Controls Norway

Healthy subjects serving as controls in Norway

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

* Above 18 years of age.
* ITB as per standard criteria a), and one or more of b) to e) must be fulfilled (Gold standard):

1. Endoscopic apparent intestinal tuberculosis: transverse ulcers, pseudopolyps, involvement of fewer than four intestinal segments, patulous ileo-coecal valve
2. Histological evidence of tubercles/granulomas with caseation necrosis in intestinal biopsies
3. DNA of M.tb detected by PCR of intestinal biopsies
4. Positive immunohistochemistry in intestinal biopsies.
5. Histological demonstration of acid fast bacilli in a lesion.
* Active Crohn's disease as per standard criteria (Gold standard), at least two of the following:

1. Clinical: inflammatory, perforating (fistulising) disease, obstructive symptoms secondary to small bowel stenosis or stricture.
2. Endoscopic: deep linear or serpingenous ulcerations, discrete ulcers in normal appearing mucosa, cobble-stoning or discontinuous or asymmetrical inflammation.
3. Radiographic: segmental disease (skip lesions), small bowel or colonic strictures, stenosis or fistula.
4. Histological: sub-mucosal or transmural inflammation, granulomas, focal cryptitis and chronic inflammatory infiltration, skip lesions including rectal sparing (no topical rectal therapy).

Exclusion Criteria

a) Age below 18 years b) HIV positive c) Malignancy
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Helse Sor-Ost

OTHER_GOV

Sponsor Role collaborator

The Unger-Vetlesen Medical Fund, Jersey, C.I

UNKNOWN

Sponsor Role collaborator

Odd Fellow Medical Fund, Norway

UNKNOWN

Sponsor Role collaborator

Lovisenberg Diakonale Hospital

OTHER

Sponsor Role lead

Responsible Party

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Oslo University Hospital, Aker

Principal Investigators

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Bjorn Moum, M.D Ph.D

Role: STUDY_CHAIR

Oslo University Hospital, Aker

Gunnar Bjune, M.D Ph.D

Role: STUDY_CHAIR

University of Oslo, Dept. of International Health

Locations

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Population Health & Research Institiute, Medical College

Trivandrum, Kerala, India

Site Status RECRUITING

Lovisenberg Diakonal Hospital

Oslo, Oslo County, Norway

Site Status ACTIVE_NOT_RECRUITING

Countries

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India Norway

Central Contacts

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Geir larsson, M.D

Role: CONTACT

+47 92045245

Facility Contacts

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KT Shenoy, M.D. Ph.D

Role: primary

+91 9447044364

References

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Larsson, G; Shenoy, KT; Roseth, A; Bjune, G; Moum, B. Diagnosis and differentiation of intestinal tuberculosis and Crohn's disease by use of faecal and serum calprotectin. INFLAMMATORY BOWEL DISEASES 17: S35-S35 Suppl. 1 JAN 2011

Reference Type RESULT

Other Identifiers

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LDS 150

Identifier Type: -

Identifier Source: org_study_id

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