Gastroduodenal tuberculosis management guidelines, based on a large experience and a review of the literature

Background: To review our experience of gastroduodenal tuberculosis before formulating management guidelines, we did a retrospective analysis at a large tertiary-care teaching institution in North India. Method: We reviewed 23 consecutive cases of biopsy-proven gastroduodenal tuberculosis over a period of 15 years. Results: The major presenting features were gastric outlet obstruction (61%) and upper gastrointestinal (uGI) bleeding (26%). In 3 patients (13%), clinical, radiological and intracoperative features suggested malignancy/pseudotumour: periampullary mass in 2 and gastric mass in I patient. Five patients (23%) also had extragastrointestinal tuberculosis. Despite uGI encloscopy and biopsies, the pre-operative diagnosis was correct for only 2 people. All patients except I required surgery for either diagnosis or therapy. Two patients with massive uGI hemorrhage requiring emergency surgery died in the postoperative period. The other patients responded well to antitubercular treatment after surgery. Conclusions: Gastrocluodenal tuberculosis has 3 forms of presentation: obstruction, uGI bleeding, and gastric or periampullary mass suggestive of malignancy. Endoscopic biopsy has a poor yield. Surgery is usually required for diagnosis or therapy, after which patients respond well to antituberculous treatment. In areas endemic for tuberculosis, a good biopsy from the site of gastroduodenal bleeding or mass lesion and the surrounding lymph nodes should always be obtained.