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2 "Vishnubhatla Sreenivas"
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Original Article
Inflammatory bowel diseases
Quantitative histology-based classification system for assessment of the intestinal mucosal histological changes in patients with celiac disease
Prasenjit Das, Gaurav PS Gahlot, Alka Singh, Vandana Baloda, Ramakant Rawat, Anil K Verma, Gaurav Khanna, Maitrayee Roy, Archana George, Ashok Singh, Aasma Nalwa, Prashant Ramteke, Rajni Yadav, Vineet Ahuja, Vishnubhatla Sreenivas, Siddhartha Datta Gupta, Govind K Makharia
Intest Res 2019;17(3):387-397.   Published online April 22, 2019
DOI: https://doi.org/10.5217/ir.2018.00167
AbstractAbstract PDFPubReaderePub
Background/Aims
The existing histological classifications for the interpretation of small intestinal biopsies are based on qualitative parameters with high intraobserver and interobserver variations. We have developed and propose a quantitative histological classification system for the assessment of intestinal mucosal biopsies.
Methods
We performed a computer-assisted quantitative histological assessment of digital images of duodenal biopsies from 137 controls and 124 patients with celiac disease (CeD) (derivation cohort). From the receiver-operating curve analysis, followed by multivariate and logistic regression analyses, we identified parameters for differentiating control biopsies from those of the patients with CeD. We repeated the quantitative histological analysis in a validation cohort (105 controls and 120 patients with CeD). On the basis of the results, we propose a quantitative histological classification system. The new classification was compared with the existing histological classifications for interobserver and intraobserver agreements by a group of qualified pathologists.
Results
Among the histological parameters, intraepithelial lymphocyte count of ≥25/100 epithelial cells, adjusted villous height fold change of ≤0.7, and crypt depth-to-villous height ratio of ≥0.5 showed good discriminative power between the mucosal biopsies from the patients with CeD and those from the controls, with 90.3% sensitivity, 93.5% specificity, and 96.2% area under the curve. Among the existing histological classifications, our quantitative histological classification showed the highest intraobserver (69.7%–85.03%) and interobserver (24.6%–71.5%) agreements.
Conclusions
Quantitative assessment increases the reliability of the histological assessment of mucosal biopsies in patients with CeD. Such a classification system may be used for clinical trials in patients with CeD. (Intest Res, Published online)

Citations

Citations to this article as recorded by  
  • Follow-up of Celiac Disease After Diagnosis
    Luca Elli, Govind K. Makharia, Daniel A. Leffler, Lucia Scaramella, Georgia Malamut
    Gastrointestinal Endoscopy Clinics of North America.2025;[Epub]     CrossRef
  • Celiac Disease Deep Learning Image Classification Using Convolutional Neural Networks
    Joaquim Carreras
    Journal of Imaging.2024; 10(8): 200.     CrossRef
  • CD, or not CD, that is the question: a digital interobserver agreement study in coeliac disease
    James Denholm, Benjamin A Schreiber, Florian Jaeckle, Mike N Wicks, Emyr W Benbow, Tim S Bracey, James Y H Chan, Lorant Farkas, Eve Fryer, Kishore Gopalakrishnan, Caroline A Hughes, Kathryn J Kirkwood, Gerald Langman, Betania Mahler-Araujo, Raymond F T Mc
    BMJ Open Gastroenterology.2024; 11(1): e001252.     CrossRef
  • Role of Serology, Dietary Assessment, and Fecal Gluten Immunogenic Peptides for Predicting Histologic Recovery in Children with Celiac Disease
    Keerthivasan Seetharaman, Sadhna Bhasin Lal, Kaushal Kishor Prasad, Yashwant Kumar, Alka Bhatia, Sunita Malhotra
    Digestive Diseases and Sciences.2023; 68(2): 529.     CrossRef
  • Usefulness of a double immunofluorescence technique for detection of intestinal tTG-IgA deposits in diabetic and non-diabetic children with celiac disease
    Raghav Lal, Ranjeet Bhardwaj, Ranjana Walker Minz, Kaushal Kishore Prasad, Sadhna Lal, Devi Dayal, Yashwant Kumar
    Pediatrics & Neonatology.2023; 64(4): 388.     CrossRef
  • The global burden of coeliac disease: opportunities and challenges
    Govind K. Makharia, Prashant Singh, Carlo Catassi, David S. Sanders, Daniel Leffler, Raja Affendi Raja Ali, Julio C. Bai
    Nature Reviews Gastroenterology & Hepatology.2022; 19(5): 313.     CrossRef
  • Gluten Induces Subtle Histological Changes in Duodenal Mucosa of Patients with Non-Coeliac Gluten Sensitivity: A Multicentre Study
    Kamran Rostami, Arzu Ensari, Michael N. Marsh, Amitabh Srivastava, Vincenzo Villanacci, Antonio Carroccio, Hamid Asadzadeh Aghdaei, Julio C. Bai, Gabrio Bassotti, Gabriel Becheanu, Phoenix Bell, Camillo Di Bella, Anna Maria Bozzola, Moris Cadei, Giovanni
    Nutrients.2022; 14(12): 2487.     CrossRef
  • The Role of Nerve Fibers in the Tumor Immune Microenvironment of Solid Tumors
    Sharia Hernandez, Alejandra G. Serrano, Luisa M. Solis Soto
    Advanced Biology.2022;[Epub]     CrossRef
  • Case Report: Morphologic and Functional Characteristics of Intestinal Mucosa in a Child With Short Bowel Syndrome After Treatment With Teduglutide: Evidence in Favor of GLP-2 Analog Safety
    Enrico Costantino Falco, Antonella Lezo, Pierluigi Calvo, Caterina Rigazio, Anna Opramolla, Ludovica Verdun, Giovanna Cenacchi, Marianna Pellegrini, Marco Spada, Gabriella Canavese
    Frontiers in Nutrition.2022;[Epub]     CrossRef
  • Quantitative histology as a diagnostic tool for celiac disease in children and adolescents
    Mateus M. Vargas, Ricardo Artigiani Neto, Vera L. Sdepanian
    Annals of Diagnostic Pathology.2022; 61: 152031.     CrossRef
  • Best practices of handling, processing, and interpretation of small intestinal biopsies for the diagnosis and management of celiac disease: A joint consensus of Indian association of pathologists and microbiologists and Indian society of gastroenterology
    Prasenjit Das, Kim Vaiphei, AnjaliD Amarapurkar, Puja Sakhuja, Ritambhra Nada, RoopaRachel Paulose, Rachana Chaturvedi, Anuradha Sekaran, Usha Kini, Archana Rastogi, Niraj Kumari, Anna Pulimood, Mala Banerjee, Prateek Kinra, Lavleen Singh, AmarenderSingh
    Indian Journal of Pathology and Microbiology.2021; 64(5): 8.     CrossRef
  • Artificial intelligence in small intestinal diseases: Application and prospects
    Yu Yang, Yu-Xuan Li, Ren-Qi Yao, Xiao-Hui Du, Chao Ren
    World Journal of Gastroenterology.2021; 27(25): 3734.     CrossRef
  • Opportunities and challenges in the management of celiac disease in Asia
    Ashish Agarwal, Ashish Chauhan, Vineet Ahuja, Govind K Makharia
    JGH Open.2020; 4(5): 795.     CrossRef
  • Digital histology in celiac disease: A practice changer
    Daniel Vasile Balaban, Mariana Jinga
    Artificial Intelligence in Gastroenterology.2020; 1(1): 1.     CrossRef
  • Digital histology in celiac disease: A practice changer
    Daniel Vasile Balaban, Mariana Jinga
    Artificial Intelligence in Gastroenterology.2020; 1(1): 1.     CrossRef
  • 8,518 View
  • 183 Download
  • 13 Web of Science
  • 15 Crossref
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Systematic Review
Accuracy of computed tomographic features in differentiating intestinal tuberculosis from Crohn's disease: a systematic review with meta-analysis
Saurabh Kedia, Raju Sharma, Vishnubhatla Sreenivas, Kumble Seetharama Madhusudhan, Vishal Sharma, Sawan Bopanna, Venigalla Pratap Mouli, Rajan Dhingra, Dawesh Prakash Yadav, Govind Makharia, Vineet Ahuja
Intest Res 2017;15(2):149-159.   Published online April 27, 2017
DOI: https://doi.org/10.5217/ir.2017.15.2.149
AbstractAbstract PDFPubReaderePub

Abdominal computed tomography (CT) can noninvasively image the entire gastrointestinal tract and assess extraintestinal features that are important in differentiating Crohn's disease (CD) and intestinal tuberculosis (ITB). The present meta-analysis pooled the results of all studies on the role of CT abdomen in differentiating between CD and ITB. We searched PubMed and Embase for all publications in English that analyzed the features differentiating between CD and ITB on abdominal CT. The features included comb sign, necrotic lymph nodes, asymmetric bowel wall thickening, skip lesions, fibrofatty proliferation, mural stratification, ileocaecal area, long segment, and left colonic involvements. Sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio (DOR) were calculated for all the features. Symmetric receiver operating characteristic curve was plotted for features present in >3 studies. Heterogeneity and publication bias was assessed and sensitivity analysis was performed by excluding studies that compared features on conventional abdominal CT instead of CT enterography (CTE). We included 6 studies (4 CTE, 1 conventional abdominal CT, and 1 CTE+conventional abdominal CT) involving 417 and 195 patients with CD and ITB, respectively. Necrotic lymph nodes had the highest diagnostic accuracy (sensitivity, 23%; specificity, 100%; DOR, 30.2) for ITB diagnosis, and comb sign (sensitivity, 82%; specificity, 81%; DOR, 21.5) followed by skip lesions (sensitivity, 86%; specificity, 74%; DOR, 16.5) had the highest diagnostic accuracy for CD diagnosis. On sensitivity analysis, the diagnostic accuracy of other features excluding asymmetric bowel wall thickening remained similar. Necrotic lymph nodes and comb sign on abdominal CT had the best diagnostic accuracy in differentiating CD and ITB.

Citations

Citations to this article as recorded by  
  • Differentiation of Crohn's disease, ulcerative colitis, and intestinal tuberculosis by dual-layer spectral detector CT enterography
    M. Huang, L. Tu, J. Li, X. Yue, L. Wu, M. Yang, Y. Chen, P. Han, X. Li, L. Zhu
    Clinical Radiology.2024; 79(3): e482.     CrossRef
  • Deep Learning Radiomics Analysis of CT Imaging for Differentiating Between Crohn’s Disease and Intestinal Tuberculosis
    Ming Cheng, Hanyue Zhang, Wenpeng Huang, Fei Li, Jianbo Gao
    Journal of Imaging Informatics in Medicine.2024; 37(4): 1516.     CrossRef
  • New diagnostic strategies to distinguish Crohn's disease and gastrointestinal tuberculosis
    Himanshu Narang, Saurabh Kedia, Vineet Ahuja
    Current Opinion in Infectious Diseases.2024; 37(5): 392.     CrossRef
  • Management and monitoring of pediatric inflammatory bowel disease in the Asia‐Pacific region: A position paper by the Asian Pan‐Pacific Society for Pediatric Gastroenterology, Hepatology, and Nutrition (APPSPGHAN) PIBD Working Group: Surgical management,
    Way Seah Lee, Katsuhiro Arai, George Alex, Suporn Treepongkaruna, Kyung Mo Kim, Chee Liang Choong, Karen Calixto Mercado, Andy Darma, Anshu Srivastava, Marion M. Aw
    Journal of Gastroenterology and Hepatology.2023; 38(4): 510.     CrossRef
  • Granulomatous bowel disease: Crohn’s disease and tuberculosis. Difficulties in differential diagnosis (case report and review)
    A. V. Vardanyan, E. S. Merkulova, V. A. Belinskaya, K. S. Frolova, O. A. Mainovskaya
    Koloproktologia.2023; 22(1): 117.     CrossRef
  • Evidence-based approach to diagnosis and management of abdominal tuberculosis
    Daya Krishna Jha, Mythili Menon Pathiyil, Vishal Sharma
    Indian Journal of Gastroenterology.2023; 42(1): 17.     CrossRef
  • Differentiating gastrointestinal tuberculosis and Crohn's disease- a comprehensive review
    Arup Choudhury, Jasdeep Dhillon, Aravind Sekar, Pankaj Gupta, Harjeet Singh, Vishal Sharma
    BMC Gastroenterology.2023;[Epub]     CrossRef
  • Recent updates in diagnosis of abdominal tuberculosis with emphasis on nucleic acid amplification tests
    Preeti Mor, Bhawna Dahiya, Sanjeev Parshad, Pooja Gulati, Promod K. Mehta
    Expert Review of Gastroenterology & Hepatology.2022; 16(1): 33.     CrossRef
  • Addition of computed tomography chest increases the diagnosis rate in patients with suspected intestinal tuberculosis
    Saurabh Kedia, Raju Sharma, Sudheer Kumar Vuyyuru, Deepak Madhu, Pabitra Sahu, Bhaskar Kante, Prasenjit Das, Ankur Goyal, Karan Madan, Govind Makharia, Vineet Ahuja
    Intestinal Research.2022; 20(2): 184.     CrossRef
  • Systematic reporting of computed tomography enterography/enteroclysis as an aid to reduce diagnostic dilemma when differentiating between intestinal tuberculosis and Crohn's disease: A prospective study at a tertiary care hospital
    Amrin Israrahmed, Rajanikant R Yadav, Geeta Yadav, Alpana, Rajesh V Helavar, Praveer Rai, Manoj Kumar Jain, Archna Gupta
    JGH Open.2021; 5(2): 180.     CrossRef
  • Intestinal Tuberculosis: A Diagnostic Challenge
    Hansang Park, Tikal Kansara, Ana M Victoria, Noella Boma, Jungrak Hong
    Cureus.2021;[Epub]     CrossRef
  • Intestinal tuberculosis or Crohn's disease: Illusion or delusion or allusion
    Saurabh Kedia, Vineet Ahuja
    JGH Open.2021; 5(2): 177.     CrossRef
  • Deep‐learning system for real‐time differentiation between Crohn's disease, intestinal Behçet's disease, and intestinal tuberculosis
    Jung Min Kim, Jun Gu Kang, Sungwon Kim, Jae Hee Cheon
    Journal of Gastroenterology and Hepatology.2021; 36(8): 2141.     CrossRef
  • Prospective validation of CD4+CD25+FOXP3+ T-regulatory cells as an immunological marker to differentiate intestinal tuberculosis from Crohn’s disease
    Ritika Rampal, Saurabh Kedia, Mohamad Nahidul Wari, Deepak Madhu, Amit Kumar Singh, Veena Tiwari, V. Pratap Mouli, Srikant Mohta, Govind Makharia, Vineet Ahuja
    Intestinal Research.2021; 19(2): 232.     CrossRef
  • Correlation-driven framework based on graph convolutional network for clinical disease classification
    Kai Cao, Ying Xiao, Muzhou Hou
    Journal of Statistical Computation and Simulation.2021; 91(15): 3108.     CrossRef
  • Difficulties in the differential diagnosis of intestinal tuberculosis and Crohn‘s disease
    M. N. Reshetnikov, D. V. Plotkin, Yu. R. Zyuzya, A. A. Volkov, O. N. Zuban, E. M. Bogorodskaya
    Acta Biomedica Scientifica.2021; 6(5): 196.     CrossRef
  • Diagnostic performance of CT for differentiating peritoneal tuberculosis from peritoneal carcinomatosis: a systematic review and meta-analysis
    J. Chen, S. Liu, Y. Tang, X. Zhang, M. Cao, Z. Xiao, M. Ren, T. Chen
    Clinical Radiology.2020; 75(5): 396.e7.     CrossRef
  • Disseminated tuberculosis presenting as massive lower gastrointestinal bleeding
    Nehal Aggarwal, SubodhKumar Mahto, Akanskha Singh, Kritika Gupta, Ankita Aneja, Anu Singh, Atul Goel
    Journal of Family Medicine and Primary Care.2020; 9(2): 1226.     CrossRef
  • Differentiating Crohn’s disease from intestinal tuberculosis
    Saurabh Kedia, Prasenjit Das, Kumble Seetharama Madhusudhan, Siddhartha Dattagupta, Raju Sharma, Peush Sahni, Govind Makharia, Vineet Ahuja
    World Journal of Gastroenterology.2019; 25(4): 418.     CrossRef
  • The potential role of CT enterography and gastrointestinal ultrasound in the evaluation of anti-tubercular therapy response of intestinal tuberculosis: a retrospective study
    Li Ma, Qingli Zhu, Yue Li, Wenbo Li, Xuan Wang, Wei Liu, Jianchu Li, Yuxin Jiang
    BMC Gastroenterology.2019;[Epub]     CrossRef
  • Indian guidelines on imaging of the small intestine in Crohn’s disease: A joint Indian Society of Gastroenterology and Indian Radiology and Imaging Association consensus statement
    Saurabh Kedia, Raju Sharma, Govind Makharia, Vineet Ahuja, Devendra Desai, Devasenathipathy Kandasamy, Anu Eapen, Karthik Ganesan, Uday C Ghosha, Naveen Kalra, R Karthikeyan, Kumble Seetharama Madhusudhan, Mathew Philip, Amarender Puri, Sunil Puri, Saroj
    Indian Journal of Radiology and Imaging.2019; 29(02): 111.     CrossRef
  • Imaging in discriminating intestinal tuberculosis and Crohn’s disease: past, present and the future
    Pradeep Goyal, Jimil Shah, Sonali Gupta, Pankaj Gupta, Vishal Sharma
    Expert Review of Gastroenterology & Hepatology.2019; 13(10): 995.     CrossRef
  • Combination of increased visceral fat and long segment involvement: Development and validation of an updated imaging marker for differentiating Crohn's disease from intestinal tuberculosis
    Saurabh Kedia, Kumble S Madhusudhan, Raju Sharma, Sawan Bopanna, Dawesh P Yadav, Sandeep Goyal, Saransh Jain, Prasenjit Das, Siddhartha Dattagupta, Govind Makharia, Vineet Ahuja
    Journal of Gastroenterology and Hepatology.2018; 33(6): 1234.     CrossRef
  • Computed Tomography Enterography: Quantitative Evaluation on Crohn’s Disease Activity
    Jingyun Cheng, Hui Xie, Hao Yang, Ke Wang, Guobin Xu, Guangyao Wu
    Gastroenterology Research and Practice.2018; 2018: 1.     CrossRef
  • Gastrointestinal Tuberculosis Presenting as Malnutrition and Distal Colonic Bowel Obstruction
    Raja Chandra Chakinala, Zahava C. Farkas, Benjamin Barbash, Khwaja F. Haq, Shantanu Solanki, Muhammad Ali Khan, Edward Esses, Taliya Farooq, Brad Dworkin
    Case Reports in Gastrointestinal Medicine.2018; 2018: 1.     CrossRef
  • Diagnostic point-of-care ultrasound (POCUS) for gastrointestinal pathology: state of the art from basics to advanced
    Fikri M Abu-Zidan, Arif Alper Cevik
    World Journal of Emergency Surgery.2018;[Epub]     CrossRef
  • Enfermedad de Crohn vs tuberculosis intestinal: un diagnóstico diferencial desafiante. Revisión de tema
    Gabriel Alonso Mosquera-Klinger, Andrea Ucroz Benavides
    Revista Colombiana de Gastroenterología.2018; 33(4): 423.     CrossRef
  • Imaging of the small intestine in Crohn’s disease: Joint position statement of the Indian Society of Gastroenterology and Indian Radiological and Imaging Association
    Saurabh Kedia, Raju Sharma, Govind K. Makharia, Vineet Ahuja, Devendra Desai, Devasenathipathy Kandasamy, Anu Eapen, Karthik Ganesan, Uday C. Ghoshal, Naveen Kalra, D. Karthikeyan, Kumble Seetharama Madhusudhan, Mathew Philip, Amarender Singh Puri, Sunil
    Indian Journal of Gastroenterology.2017; 36(6): 487.     CrossRef
  • Editor’s Pick: Recent Advances in the Diagnosis and Management of Abdominal Tuberculosis
    Harshal S. Mandavdhare, Harjeet Singh, Vishal Sharma
    EMJ Gastroenterology.2017; : 52.     CrossRef
  • 8,978 View
  • 149 Download
  • 28 Web of Science
  • 29 Crossref
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