Intestinal Tuberculosis (Aant Ki TB) Treatment in Indore

What is Intestinal Tuberculosis?

Intestinal tuberculosis or as it is known in many households ‘aant ki TB’ is an infection of the intestines caused by Mycobacterium tuberculosis the same bacterium that causes tuberculosis of the lungs. Tuberculosis is not merely a disease of the chest. It can settle in the lymph glands, bones, brain and abdomen. When it involves the abdomen doctors speak of abdominal tuberculosis, which may involve the intestines, the lining of the abdominal cavity (peritoneum), the lymph nodes and solid organs such as the liver and spleen.

The disease is far more common in countries such as India, where tuberculosis is prevalent. The commonest site in the intestine is the ileocaecal region where the small bowel joins the large bowel. Intestinal TB has an insidious onset often over months, and the symptoms are non-specific. That is why so many patients are treated for acidity, worms or irritable bowel for a long time before the actual cause is found.

The good news is that intestinal tuberculosis responds well to full course of anti-tubercular medicines when diagnosed on time. Dr. Kriti Bansal in assesses and treats abdominal tuberculosis, taking special care to differentiate it from Crohn’s disease and other look-alike conditions. Intestinal Tuberculosis Treatment in Indore The first step is to confirm the diagnosis, as the symptoms are similar to other bowel diseases.

Forms of Abdominal Tuberculosis

• Intestinal TB: Ulcers or thickening of the bowel wall, usually of the ileum and caecum, causing narrowing.
• Peritoneal TB: Infection of the lining of the abdomen, causing fluid to collect in the abdomen (ascites), doughy feeling of the belly and pain.
• Tuberculous lymphadenopathy: Enlarged lymph nodes in the abdomen that may cause pressure on surrounding structures.
• Visceral TB: Less common involvement of the liver, spleen or pancreas.

More than one form can be present in the same patient and some patients have also pulmonary TB.

Signs of intestinal tuberculosis

Features depend upon the type and extent of disease and develop gradually.

• Persistent abdominal pain: Dull, cramping pain, often in the lower right abdomen or around the navel, that worsens after eating.
• Fever: Low grade temperature, usually in the afternoon or evening, with nite sweats.
• Loss of appetite and weight loss: Consistent weight loss and lack of interest in food, along with weakness.
• Change in bowel habits, such as diarrhea, constipation or alternating episodes Blood in stool is less common in colitis.
• Abdominal lump: Hard swelling in the right lower abdomen due to thickened bowel and enlarged glands.
• Swollen belly: Fluid build-up due to peritoneal involvement.
• Intestinal obstruction: Scarring narrows the bowel, resulting in colicky pain, vomiting, bloating and inability to pass gas or stool.
• Anemia and fatigue: Poor appetite, poor absorption and chronic illness.

Causes of TB of Intestines

The disease is caused by the bacillus tuberculosis, which reaches the intestine by several ways. Infected lungs can cough up bacteria which can be swallowed and take up residence in the gut. The germs may be transported through the blood stream from some other focus in the body. Another pathway is the consumption of unpasteurized milk from an infected animal and spread from nearby infected glands is possible.

• Weak immunity: HIV infection, poorly controlled diabetes, malnutrition, alcohol dependence and long-term steroid use make people prone to infection.
• Immunosuppressive treatment: Drugs like anti-TNF biologics can lead to reactivation of latent infection.
• Close contact: Sharing a living space with someone with active, untreated TB raises the risk of exposure.
• Overcrowded or poorly ventilated housing: These facilitate the spread of bacteria in the community.
• Chronic kidney disease and cirrhosis: Both compromise resistance to infection.

Complications if Left Untreated

If not treated, the ulcers heal by scarring, and the scarring can cause the bowel to tighten into strictures that block the passage of food. Perforation of the bowel can lead to peritonitis, a life-threatening infection of the abdominal cavity. Fistulas, abscesses and bleeding can occur. A long illness leads to severe malnutrition and anemia. Adhesions tie loops of bowel together (may be due to peritoneal TB). Most of these problems can be avoided by early diagnosis and treatment of the infection.

How Intestinal Tuberculosis Is Diagnosed

Abdominal TB is difficult to diagnose as there are few bacteria in the bowel and tests are not always positive even when disease is present. The doctor then puts several findings together. An intestinal TB specialist in Indore considers the results of colonoscopy, biopsy and imaging as a whole to arrive at a diagnosis.
Blood tests: Anemia, raised ESR and CRP and low albumin are common but not specific.

• Chest X-ray and Sputum tests: Used to determine lung involvement.
• Mantoux test or interferon-gamma release assay: These indicate TB exposure but do not rule out active gut disease.
• CT scan or ultrasound of abdomen: Thickening of bowel segments, enlarged lymph nodes with necrosis, ascites, thickening of omentum and strictures.
• Colonoscopy with biopsy: Ulcers running around the bowel (transverse ulcers) are typical, and there is a patulous ileocaecal valve and nodules. Biopsies are examined for granulomas with caseation, stained for acid fast bacilli and tested by culture and molecular tests like CBNAAT or PCR.
• Ascitic fluid analysis: In peritoneal TB, the fluid sample shows high protein, lymphocytes and raised level of ADA.
• Laparoscopy: Occasionally used to see into the abdomen and to take a biopsy of the peritoneum.

If tests are still not conclusive but the picture strongly suggests TB, the doctor may start a trial of anti-tubercular treatment and review the response after about eight to 12 weeks, including repeat colonoscopy. This method is used with caution, and it is of particular importance in patients for whom treatment for Crohn’s disease is being considered.

Treatment of Tuberculosis of Intestines

Abdominal tuberculosis is treated medically in almost all patients and surgery is needed only for complications. Treatment for abdominal tuberculosis in Indore is mainly medical and consists of a long uninterrupted course of anti-tubercular medicines.

Anti-tubercular therapy

Treatment is a combination of medicines to stop resistance. The usual regimen is four drugs — isoniazid, rifampicin, pyrazinamide and ethambutol — for the first two months, followed by isoniazid and rifampicin for the next four months. The total duration is typically six months, but can be extended to nine months in selected patients based on response. The tablets are taken daily, as prescribed by the doctor, often with a dose of vitamin B6 to protect the nerves.

Monitoring during treatment

Liver function is monitored at the start of treatment and throughout, as TB drugs can cause inflammation of the liver. Patients are told to look out for signs such as persistent vomiting, yellow eyes, dark urine, rash, joint pain or blurred vision and to call the doctor straight away if these occur. At every visit weight, appetite, temperature and abdominal pain are noted.

Drug resistant TB

When bacteria are resistant to standard drugs, another, longer regimen is necessary. Tissue is tested for molecular resistance and treatment is started according to national program guidelines.

Nutrition and supportive care

Recovery is aided by a diet high in protein and calories. Iron, folic acid and vitamin D can be added. In patients with narrowing a soft low residue diet is recommended.

Surgery and procedures

Surgery is for obstruction that doesn’t improve, perforation, abscess, bleeding or unclear diagnosis requiring tissue. Selected people with short strictures can be relieved with endoscopic balloon dilatation. Anti–tubercular treatment is continued around any procedure.

Follow-Up and Prevention

After treatment is complete, a review confirms that symptoms have settled, weight has returned to normal and, if needed, that colonoscopy or imaging shows healing. Finish the whole course You may start to feel better before you finish the course of medicine but stopping too soon lets surviving bacteria multiply and become resistant to medicines.

You can screen household contacts. Good ventilation at home, treating diabetes, and avoiding unpasteurized milk can reduce the risk of infection, as can a well-rounded diet. TB screen should be done on anyone starting biologic therapy for another condition.

Peritoneal Tuberculosis and Fluid in the Abdomen

In some patients the TB affects the lining of the abdomen and not the bowel itself. The abdomen becomes distended with fluid and the patient has fever, loss of weight and vague pain. The most helpful thing is to look at the fluid. Signs of TB are high protein levels, predominance of lymphocytes and high levels of ADA enzyme. CT scans may show enhancement and thickening of the lining and omentum. Fluid can be caused by liver cirrhosis, cancer, and heart disease, so the doctor looks at results together. Treatment with anti-tubercular medicines usually clears the fluid over weeks and patient is monitored for adhesions and obstruction later.

Intestinal TB in Special Situations

• HIV-positive patients: The disease may be more widespread and atypical, drug interactions need careful planning.
• Patients with diabetes: Control of blood sugar is important for recovery and may need to be adjusted while on treatment.
• Pregnancy: Anti-tubercular drugs are commonly used during pregnancy as untreated TB is more dangerous than drugs
• Patients with liver disease: Regimens are modified and closely monitored in liver.
• Children: Treatment is based on body weight, taking nutrition and growth into account.

Practical Tips for Completing Treatment

The greatest difficulty with treating tuberculosis is that it requires a commitment of several months. There are some practical actions you can take.

• Take the tablets at the same time each day, preferably when your stomach is empty as advised. Set an alarm or use a pill box.
• Write down your doses and bring them to each appointment.
• A few minor reactions can be dealt with by simple adjustment so ask your doctor before making any change and do not stop medicines because of mild nausea or itching.
• Eat regular meals, high in protein.
• Avoid alcohol.
• Do not take any herbal or over-the-counter medicines without checking as some can put strain on the liver.
• Having family support makes a big difference, and many patients benefit from having a family member help remind them.

Common Misconceptions About Abdominal TB

• TB affects the lungs only.: It can affect any organ including intestines. Intestinal TB is common.
• Negative test means no TB.: Tests of intestinal tissue often turn out negative regardless of whether the disease is present, so the doctor combines clinical, endoscopic and imaging findings.
• Surgery is needed to cure TB.: Most people get better with medicines alone.
• People only need TB medicines until they feel better. You need to take the full course to kill the bacteria, otherwise they can become resistant.

Why Choose Dr. Kriti Bansal

Dr. Kriti Bansal discusses the similarities between intestinal TB and Crohn’s disease. She looks at colonoscopy findings, tissue results and imaging together before coming to a diagnosis, because the treatments are very different and a wrong start can cost months.

In the long course of medicines, she schedules regular check-ins to watch the response, monitor liver tests and help the patient stay on track, which is the most important factor in completing treatment.

Patients seeking an intestinal TB doctor in Indore can get testing, endoscopy and follow up organized in a connected way.

Book a Consultation

Phone: +91-7610102710
Email: drkritigastro@gmail.com