Transforming intestinal tuberculosis management: advances in diagnostics, therapeutics, and prevention

Abstract Background Intestinal tuberculosis (ITB), predominantly caused by Mycobacterium tuberculosis , remains a significant global health challenge with increasing morbidity rates. As the second most common site of extrapulmonary tuberculosis after lymph nodes, ITB accounts for approximately 50% of abdominal tuberculosis cases, particularly affecting populations in resource-limited settings. Purpose To comprehensively evaluate recent advances in ITB management, focusing on innovative diagnostic approaches, therapeutic strategies, and preventive measures while addressing the challenges in clinical practice and research gaps. Main body Contemporary diagnostic advances incorporate molecular techniques (PCR, LAMP), breath volatile organic compound analysis, and AI-assisted imaging, demonstrating improved sensitivity compared to conventional methods. However, the standard 6–9-month antituberculosis treatment shows limited success (60–70%) due to poor drug penetration and emerging resistance. Novel therapeutic approaches, including targeted drug delivery systems, host-directed therapies, and precision medicine based on pharmacogenomics, show promising results in preliminary studies. The integration of microbiome research has revealed crucial insights into disease pathogenesis and treatment responses. Prevention strategies focusing on high-risk population screening, prophylactic interventions, and socioeconomic measures demonstrate potential in reducing disease burden. Short conclusion A multifaceted approach combining advanced diagnostics, optimized therapeutics, and strategic prevention is essential for addressing the global ITB burden. Future research should focus on developing point-of-care diagnostics, personalized treatment protocols, and evidence-based preventive strategies to improve patient outcomes. Article highlights • Novel molecular diagnostics and AI-assisted imaging significantly improve early detection rates of intestinal tuberculosis. • Integration of microbiome research reveals new therapeutic targets and treatment response predictors. • Personalized medicine approaches show promise in optimizing treatment outcomes and reducing therapy duration. Graphical Abstract