SNFGE SNFGE
 
Thématique :
- MICI
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Vered ABITBOL-SELINGER
Coup de coeur :
 
 
The American Journal of Gastroenterology
  2017/03  
 
  2017 Mar;112(3):415-427.  
  doi: 10.1038/ajg.2016.529.  
 
  Meta-Analytic Bayesian Model For Differentiating Intestinal Tuberculosis from Crohn's Disease  
 
  Limsrivilai J, Shreiner AB, Pongpaibul A, Laohapand C, Boonanuwat R, Pausawasdi N, Pongprasobchai S, Manatsathit S, Higgins PD  
  https://www.ncbi.nlm.nih.gov/pubmed/28045023  
 
 

Abstract

OBJECTIVES:

Distinguishing intestinal tuberculosis (ITB) from Crohn's disease (CD) is difficult, although studies have reported clinical, endoscopic, imaging, and laboratory findings that help to differentiate these two diseases. We aimed to produce estimates of the predictive power of these findings and construct a comprehensive model to predict the probability of ITB vs. CD.

METHODS:

A systematic literature search for studies differentiating ITB from CD was conducted in MEDLINE, PUBMED, and EMBASE from inception until September 2015. Fifty-five distinct meta-analyses were performed to estimate the odds ratio of each predictive finding. Estimates with a significant difference between CD and ITB and low to moderate heterogeneity (I2<50%) were incorporated into a Bayesian prediction model incorporating the local pretest probability.

RESULTS:

Thirty-eight studies comprising 2,117 CD and 1,589 ITB patients were included in the analyses. Findings in the model that significantly favored CD included male gender, hematochezia, perianal disease, intestinal obstruction, and extraintestinal manifestations; endoscopic findings of longitudinal ulcers, cobblestone appearance, luminal stricture, mucosal bridge, and rectal involvement; pathological findings of focally enhanced colitis; and computed tomographic enterography (CTE) findings of asymmetrical wall thickening, intestinal wall stratification, comb sign, and fibrofatty proliferation. Findings that significantly favored ITB included fever, night sweats, lung involvement, and ascites; endoscopic findings of transverse ulcers, patulous ileocecal valve, and cecal involvement; pathological findings of confluent or submucosal granulomas, lymphocyte cuffing, and ulcers lined by histiocytes; a CTE finding of short segmental involvement; and a positive interferon-γ release assay. The model was validated by gender, clinical manifestations, endoscopic, and pathological findings in 49 patients (27 CD, 22 ITB). The sensitivity, specificity, and accuracy for diagnosis of ITB were 90.9%, 92.6%, and 91.8%, respectively.

CONCLUSIONS:

A Bayesian model based on the meta-analytic results is presented to estimate the probability of ITB and CD calibrated to local prevalence. This model can be applied to patients using a publicly available web application.

 

 
Question posée
 
La distinction entre maladie de Crohn digestive et tuberculose est parfois difficile. Les auteurs ont construit un modèle prédictif pour aider à distinguer le diagnostic de tuberculose de la maladie de Crohn.
 
Question posée
 
Un modèle statistique basé sur des résultats de méta-analyses est présenté pour estimer la probabilité diagnostique de tuberculose ou de maladie de Crohn tenant compte de la prévalence géographique locale.
 
Commentaires

Ce modèle pourrait être utilisé via une web-application.

 
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