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Suggest Treatment For Abdominal TB
Question: Hi,
I was diagnosed with TB 4 months back.
These were my complaints, symptoms and findings:
Abdominal pain and crampy feeling
Loss of appetite
Weight Loss around 4-5 kg
Slight breathing problem
My doctor advised me to do ultrasound and CT-Scan abdomen
Ultrasound revealed mild ascitis and moderate right pleural effusion
CXR revealed passive atelectasis of right lung,pleural effusion,enlarged mammary and cardio phrenic lymphnodes and parenchymal scars
CT abdomen showed mild peritoneal thickening,moderate ascitis,heterogeneously enhancing necrotic mesenteric and retroperitoneal lymphnodes, omental nodules, multifcal circumferential symmetric small bowel wall thickening
Ascitic and pleural fluid was aspirated.
Malignancy test was negative
WBC and RBC counts were higher in ascitic fluid
There was exudative lymphocytic effusion in both .pleural and ascitic fluid
ADA level was 36 in pleural and 40 in ascitic fluid
GeneXpert came -ve but based on above findings I was started on TB treatment
In follow up ultrasound after 1.5 months, pleural effusion and ascitis were not found
Some lymphadenopathy was dere.
After 4 months, I still have almost a constant crampy abdominal pain..nd lot of burping and belching nd wind movement and gas formation..also frequent bloating..weight gain is not much around 1-1.5 kg
Stools are sometimes slightly constipated
Started with IMG,Rifamicin,Ethambutol nd Pyrazinamide for 2 months
Now continuing with R-Cinex
Antacids like Pantocid and digestives like aristozyme haven't really solved the digestive problem
Do such digestive symptoms appear in abdominal tb?it's causing lot of anxiety and making me feel low
I can attach my reports if requested
Could I be having some functional problem like IBS?
I was diagnosed with TB 4 months back.
These were my complaints, symptoms and findings:
Abdominal pain and crampy feeling
Loss of appetite
Weight Loss around 4-5 kg
Slight breathing problem
My doctor advised me to do ultrasound and CT-Scan abdomen
Ultrasound revealed mild ascitis and moderate right pleural effusion
CXR revealed passive atelectasis of right lung,pleural effusion,enlarged mammary and cardio phrenic lymphnodes and parenchymal scars
CT abdomen showed mild peritoneal thickening,moderate ascitis,heterogeneously enhancing necrotic mesenteric and retroperitoneal lymphnodes, omental nodules, multifcal circumferential symmetric small bowel wall thickening
Ascitic and pleural fluid was aspirated.
Malignancy test was negative
WBC and RBC counts were higher in ascitic fluid
There was exudative lymphocytic effusion in both .pleural and ascitic fluid
ADA level was 36 in pleural and 40 in ascitic fluid
GeneXpert came -ve but based on above findings I was started on TB treatment
In follow up ultrasound after 1.5 months, pleural effusion and ascitis were not found
Some lymphadenopathy was dere.
After 4 months, I still have almost a constant crampy abdominal pain..nd lot of burping and belching nd wind movement and gas formation..also frequent bloating..weight gain is not much around 1-1.5 kg
Stools are sometimes slightly constipated
Started with IMG,Rifamicin,Ethambutol nd Pyrazinamide for 2 months
Now continuing with R-Cinex
Antacids like Pantocid and digestives like aristozyme haven't really solved the digestive problem
Do such digestive symptoms appear in abdominal tb?it's causing lot of anxiety and making me feel low
I can attach my reports if requested
Could I be having some functional problem like IBS?
Brief Answer:
you may take a little
Detailed Answer:
Hi XXXXXXX
Welcome to HCM. This is one of the common problems my patients complain, who are under treatment for abdominal TB. The fact that your lung symptoms receded with ATT (TB drugs) indicates that the diagnosis is not wrong. (Sometimes, abdominal TB mimics CROHN'S disease, and it is often very difficult to differentiate between the two.)
Let me assure you that you may take a little while (may be one more month) to become symptom free. Same time, it is important to undergo periodical check scans just to make sure that you have not developed intestinal strictures, a rare problem with TB, which needs a different approach.
Unless you have severe abdominal pain with vomiting or severe constipation, you may wait for sometime before you respond.
I would suggest you to start on split-meal program where meals are split into small volumes to facilitate easy absorption. Avoid raw dal, spicy foods, excess protein and fat diets.
pancreatic supplements (eg: CREON 40000 U) though have no theoretical role, have helped some of my patients. you may take 1 tablet before each meal.
Coming to your doubt regarding IBS, the answer is NO at the moment as any evidence of a pathological process (in your case, pleural effusion, ascites) is against the diagnosIs of IBS.
HOPE THIS HELPS. Pls revert back if you have further queries.
you may take a little
Detailed Answer:
Hi XXXXXXX
Welcome to HCM. This is one of the common problems my patients complain, who are under treatment for abdominal TB. The fact that your lung symptoms receded with ATT (TB drugs) indicates that the diagnosis is not wrong. (Sometimes, abdominal TB mimics CROHN'S disease, and it is often very difficult to differentiate between the two.)
Let me assure you that you may take a little while (may be one more month) to become symptom free. Same time, it is important to undergo periodical check scans just to make sure that you have not developed intestinal strictures, a rare problem with TB, which needs a different approach.
Unless you have severe abdominal pain with vomiting or severe constipation, you may wait for sometime before you respond.
I would suggest you to start on split-meal program where meals are split into small volumes to facilitate easy absorption. Avoid raw dal, spicy foods, excess protein and fat diets.
pancreatic supplements (eg: CREON 40000 U) though have no theoretical role, have helped some of my patients. you may take 1 tablet before each meal.
Coming to your doubt regarding IBS, the answer is NO at the moment as any evidence of a pathological process (in your case, pleural effusion, ascites) is against the diagnosIs of IBS.
HOPE THIS HELPS. Pls revert back if you have further queries.
Above answer was peer-reviewed by :
Dr. Raju A.T
Thanks for your advice Sir..
I did an upper GI endoscopy after completing 4 months..everything was normal..
I had the following queries
1.The thing disturbing me is the persistent stomach pain(crampy feeling and frequent bloating).It is of diffuse nature.It stays all the time.Only changes in intensity with burping and passing wind.Food absorption is not happening properly and whatever I eat(even bland food) there is associated burping, belching and passing wind(count would be around 50 times a day I think).But there has never been any vomiting.When I drink water it forced out some gas..as a result I have not gained much weight also..like 1-1.5kg only in 4 months.Is the bowel wall thickening causing the digestive issues?Can exercises and yoga help?
2.Do you have any patients under you for abdominal TB currently or recently cured.Did they have such severe gastrointestinal symptoms or just mild gastritis?A word or two with them can help me a lot psychologically(I am under immense stress because I am in the dark about how its healing because people keep telling that one should gain more weight when one is responding to the treatment) at least on the initial symptoms and the impact after taking meds and the rate of healing.If possible can you share any of their contact details?Also my doctor says after 6 months CT will be done and most likely my treatment may be extended for 1-3 months more.How long(no of months-people keep saying that in 3-4 months people start feeling better usually) did your abdominal TB patients take to feel better and improved and relieved of GI symptoms
3.My diet is as follows usually( 4 times a day):
Breakfast(R-cinex 1 hour before breakfast in empty stomach) at around 9-9.30 am comprising of 2-3 cut fruits(1 apple, 1 banana, 1 orange/pomegranate) followed by a boiled egg and cornflakes/milk
Lunch around 1-2 pm comprising of rice,dal+vegetable curry/paneer curry/soyabean and rarely chicken/fish(maybe 2 times a month)
Snacks around 6-7 pm(dates or threptin biscuits with a glass of milk)
Dinner around 10-10.30 comprising of chapatti and some veg curry(mix of carrot,brinjal,potato)/ridge gourd/bottle gourd/paneer/soya/lady's finger etc.
Do you want to recommenced any changes?Could I be having some food allergy? I sometimes oversleep as I feel low and depressed...does that lead to more digestion probs?
4.Also my ascitic and pleural fluid culture failed to detect bacteria but doctor said that since fluids were resorped after 6 weeks,it is responding and i should continue. Also my ESR before hospital discharge hovered around 12(which they said high indicating inflammation). Last month it came 22.I know its non specific test but still any conclusions from it?Can chron's/IBS cause pleural effusion?
If you don't mind can you share me your mail id/contact no so that i can have a brief minute discussion?
I did an upper GI endoscopy after completing 4 months..everything was normal..
I had the following queries
1.The thing disturbing me is the persistent stomach pain(crampy feeling and frequent bloating).It is of diffuse nature.It stays all the time.Only changes in intensity with burping and passing wind.Food absorption is not happening properly and whatever I eat(even bland food) there is associated burping, belching and passing wind(count would be around 50 times a day I think).But there has never been any vomiting.When I drink water it forced out some gas..as a result I have not gained much weight also..like 1-1.5kg only in 4 months.Is the bowel wall thickening causing the digestive issues?Can exercises and yoga help?
2.Do you have any patients under you for abdominal TB currently or recently cured.Did they have such severe gastrointestinal symptoms or just mild gastritis?A word or two with them can help me a lot psychologically(I am under immense stress because I am in the dark about how its healing because people keep telling that one should gain more weight when one is responding to the treatment) at least on the initial symptoms and the impact after taking meds and the rate of healing.If possible can you share any of their contact details?Also my doctor says after 6 months CT will be done and most likely my treatment may be extended for 1-3 months more.How long(no of months-people keep saying that in 3-4 months people start feeling better usually) did your abdominal TB patients take to feel better and improved and relieved of GI symptoms
3.My diet is as follows usually( 4 times a day):
Breakfast(R-cinex 1 hour before breakfast in empty stomach) at around 9-9.30 am comprising of 2-3 cut fruits(1 apple, 1 banana, 1 orange/pomegranate) followed by a boiled egg and cornflakes/milk
Lunch around 1-2 pm comprising of rice,dal+vegetable curry/paneer curry/soyabean and rarely chicken/fish(maybe 2 times a month)
Snacks around 6-7 pm(dates or threptin biscuits with a glass of milk)
Dinner around 10-10.30 comprising of chapatti and some veg curry(mix of carrot,brinjal,potato)/ridge gourd/bottle gourd/paneer/soya/lady's finger etc.
Do you want to recommenced any changes?Could I be having some food allergy? I sometimes oversleep as I feel low and depressed...does that lead to more digestion probs?
4.Also my ascitic and pleural fluid culture failed to detect bacteria but doctor said that since fluids were resorped after 6 weeks,it is responding and i should continue. Also my ESR before hospital discharge hovered around 12(which they said high indicating inflammation). Last month it came 22.I know its non specific test but still any conclusions from it?Can chron's/IBS cause pleural effusion?
If you don't mind can you share me your mail id/contact no so that i can have a brief minute discussion?
Brief Answer:
Do not worry unless u see red flag symptoms.
Detailed Answer:
Hi,
I can understand your concern. "multifocal circumferential symmetric small bowel wall thickening along with peritoneal involvement" is the one that is rarely seen in abdominal TB . This is rare and also severe form, because of which you are seeing symptoms which are uncommonly seen in simple abdominal cases.
Many of my patients had similar problems that got abated over time. sometimes we have to go and get a biopsy from the caecum or terminal ileum to correctly pick TB. But because you have shown good response with the drugs, your doc probably wants to postpone those expensive and cumbersome investigations.
From the diet point, i would suggest you to reduce high protein foods like threptin biscuits and dal for a few days till you get relieved as they may not be tolerated well.Rest of your diet chart is good.
I may have to apologize for not being helpful in terms of giving numbers of myself/my patients as it is against the laws of the portal as well as ethical conduct, though i know that u have a genuine request to make. But i can assure you that things will ease out as time runs. Do not hesitate to consult your doc and get a follow up scan or further evaluation if you develop any red flags like severe pain abdomen, absolute constipation or vomitings.
As i already told, crohn's disease remains tough challenge for many cases of abdominal TB and one can not exclude it with certainty without taking a biopsy. Blood tests like ASCA can help to some extent. At this point, IBS is a far stretched diagnosis, just ignore it.
In my extremely busy schedule, i may take a while to reply back, please excuse. Hope i have cleared some of your doubts.
Do not worry unless u see red flag symptoms.
Detailed Answer:
Hi,
I can understand your concern. "multifocal circumferential symmetric small bowel wall thickening along with peritoneal involvement" is the one that is rarely seen in abdominal TB . This is rare and also severe form, because of which you are seeing symptoms which are uncommonly seen in simple abdominal cases.
Many of my patients had similar problems that got abated over time. sometimes we have to go and get a biopsy from the caecum or terminal ileum to correctly pick TB. But because you have shown good response with the drugs, your doc probably wants to postpone those expensive and cumbersome investigations.
From the diet point, i would suggest you to reduce high protein foods like threptin biscuits and dal for a few days till you get relieved as they may not be tolerated well.Rest of your diet chart is good.
I may have to apologize for not being helpful in terms of giving numbers of myself/my patients as it is against the laws of the portal as well as ethical conduct, though i know that u have a genuine request to make. But i can assure you that things will ease out as time runs. Do not hesitate to consult your doc and get a follow up scan or further evaluation if you develop any red flags like severe pain abdomen, absolute constipation or vomitings.
As i already told, crohn's disease remains tough challenge for many cases of abdominal TB and one can not exclude it with certainty without taking a biopsy. Blood tests like ASCA can help to some extent. At this point, IBS is a far stretched diagnosis, just ignore it.
In my extremely busy schedule, i may take a while to reply back, please excuse. Hope i have cleared some of your doubts.
Above answer was peer-reviewed by :
Dr. Veerisetty Shyamkumar
Answered by
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