Publication Details
Abstract
Despite a long-standing understanding of the disease, tuberculosis (TB) is still a leading cause of morbidity and mortality globally, with >10 million cases per year and high mortality due to complications. Background: Gastrointestinal (GI) disorders are common in tuberculosis (TB) patients, particularly those with multidrug-resistant (MDR)-TB, and greatly impact treatment adherence and outcomes. Gi complications, albeit clinically relevant, are insuffi ciently integrated into standard clinical care in terms of pathophysiologic mechanisms, diagnostic algorithms, and management of complications16,17. In this review, we analyze the pathogenesis, clinical features, diagnosis and current treatment approaches of tuberculosis associated with gastrointestinal involvement. Gastrointestinal (GI) complications occur via multifactorial mechanisms involving direct mycobacterial infection, systemic inflammation, drug-induced toxicity, dysbiosis, and nutrient deficiencies. The clinical manifestations can vary from dyspepsia and malabsorption to a severe drug-induced hepatitis (Table 1). Biopsy remains the gold standard but diagnostic algorithms integrate biochemical, endoscopic, and imaging modalities. There is an overarching approach based on early identification, monitoring of hepatotoxicity, nutritional support, and multidisciplinary care. This article reviews the currently available evidence on the potency relationship between tuberculosis (TB) treatment and GI health, underscores the notion of a cumulative effect created by the interlinked pathophysiological pathways and suggests integrative approaches considering the synergy for enhanced safety and efficacy. Appropriate interventions for GI complication with all armamentaria will augment compliance with therapy, decrease toxicity, and improve outcome of care in tuberculosis.