Systematic review with meta‐analysis: Accuracy of interferon‐gamma releasing assay and anti‐Saccharomyces cerevisiae antibody in differentiating intestinal tuberculosis from Crohn's disease in Asians
Open Access
- 9 June 2014
- journal article
- research article
- Published by Wiley in Journal of Gastroenterology and Hepatology
- Vol. 29 (9), 1664-1670
- https://doi.org/10.1111/jgh.12645
Abstract
Background and Aims Distinguishing Crohn's disease (CD) from intestinal tuberculosis (ITB) is a clinical challenge. This meta‐analysis assessed the clinical usefulness of Interferon‐gamma releasing assay (IGRA) and anti‐Saccharomyces cerevisiae antibody (ASCA) in the diagnosis of ITB and CD, respectively. Methods Systematic search without language restriction was conducted in AMED, EBM, MEDLINE, EMBASE, and Google Scholar until September 2013. Studies that have evaluated performance of IGRA (QuantiFERON‐TB Gold or T‐SPOT.TB) or ASCA in distinguishing ITB from CD were eligible. Main outcome measures included sensitivity and specificity. Random‐effects models were used to combine estimates from studies with significant heterogeneity. Area under the curve (AUC) was used to measure accuracy of the tests. Results Eleven studies (five IGRA, three ASCA, three IGRA and ASCA) involving 1081 subjects were included. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of IGRA for the diagnosis of ITB was 81% (95% CI, 75–86%), 85% (95% CI, 81–89%), 6.02 (95% CI: 4.62–7.83), and 0.19 (95% CI: 0.10–0.36), respectively. The AUC was 0.92. The pooled sensitivity and specificity of ASCA for the diagnosis of CD was 33% (95% confidence interval [CI], 27%–38%) and 83% (95% CI, 77–88%), respectively with an AUC of 0.58. T‐SPOT.TB showed a higher sensitivity than QuantiFERON‐TB Gold for the diagnosis of ITB. Conclusions IGRA and ASCA have a high specificity for the diagnosis of ITB. Both IGRA and ASCA may have a supplementary role in the differential diagnosis between ITB and CD when conventional workup is not diagnostic.Keywords
This publication has 22 references indexed in Scilit:
- Utility of in vitro interferon‐γ release assay in differential diagnosis between intestinal tuberculosis and Crohn's diseaseJournal of Digestive Diseases, 2012
- Increasing Incidence and Prevalence of the Inflammatory Bowel Diseases With Time, Based on Systematic ReviewGastroenterology, 2012
- QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy StudiesAnnals of Internal Medicine, 2011
- The Usefulness of In Vitro Interferon-γ Assay for Differential Diagnosis between Intestinal Tuberculosis and Crohn's DiseaseThe Korean Journal of Gastroenterology, 2010
- In Situ PCR forMycobacterium tuberculosisin Endoscopic Mucosal Biopsy Specimens of Intestinal Tuberculosis and Crohn DiseaseAmerican Journal of Clinical Pathology, 2008
- Review article: the diagnosis and management of Crohn’s disease in populations with high‐risk rates for tuberculosisAlimentary Pharmacology & Therapeutics, 2007
- Meta-analysis: New Tests for the Diagnosis of Latent Tuberculosis Infection: Areas of Uncertainty and Recommendations for ResearchAnnals of Internal Medicine, 2007
- Anti-Saccharomyces cerevisiae antibody is not useful to differentiate between Crohn′s disease and intestinal tuberculosis in IndiaJournal of Postgraduate Medicine, 2007
- Anti-Saccharomyces cerevisiae Antibody Does Not Differentiate Between Crohn's Disease and Intestinal TuberculosisDigestive Diseases and Sciences, 2006
- Systematic reviews in health care: Systematic reviews of evaluations of diagnostic and screening testsBMJ, 2001