Diagnostic barriers in gastrointestinal tuberculosis

<bold>Background:</bold> Diagnosis of gastrointestinal tuberculosis (GI TB) remains challenging. There is often a delay, while signs and symptoms may be confused with inflammatory bowel disease. <bold>Methods:</bold> We conducted a retrospective study of all consecutive patients diagnosed at a London (UK) Hospital with GI TB between 2017 and 2023. <bold>Results:</bold> Sixty-six patients with GI TB were included. Fifty of these were migrants, 43 were male and the median age was 42 years (iQR 26). Thirty-two out of 66 (48%) presented via the emergency department and 22 out of 66 (33%) to their general practitioner. The time from presentation to referral to TB services ranged from 0 to 629 days (median 29, iQR 86). Presenting symptoms included abdominal pain (70%), nausea (35%), diarrhoea (18%), abdominal distension (19%), constipation (12%), weight loss (48%) and fevers (39%). Fifty-seven patients underwent a CT abdomen, showing features suggestive of GI TB. Forty-nine (74%) of patients had a CT chest and eight underwent PET scans. Thirty-two (49%) had microbiological confirmation of TB, with 12 (18%) coming from extra abdominal sampling sites. 47 patients (71%) had histological evidence of granuloma. <bold>Conclusion:</bold> CT CAP or PET CT may be of benefit in diagnosis of GI TB to guide microbiological sampling and biopsy of extra-abdominal sites, especially in cases of diagnostic uncertainty. <fig><object-id>erj;64/suppl_68/PA5054/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>