The Usefulness of Angiotensin Converting Enzyme in the Differential Diagnosis of Crohn's Disease and Intestinal Tuberculosis

Overview

Journal Korean J Intern Med

Specialty General Medicine

Date 2007 Apr 13

PMID 17427637

Citations 3

Authors

Chang-Il Kwon

Pil Won Park

Haeyoun Kang

Gwang Il Kim

Sung Tae Cha

Kyung Soo Kim

Kwang Hyun Ko

Sung Pyo Hong

Seong Gyu Hwang

Kyu Sung Rim

Affiliations

Soon will be listed here.

Abstract

Background: Since the pathologic findings of Crohn's disease (CD) and intestinal tuberculosis (IT) overlap to a large degree, the development of other biomarkers will be of great help for making the differential diagnosis of these 2 diseases. The aim of the present study is to examine the clinical efficacy of using the tissue angiotensin converting enzyme (ACE) assay in making the differential diagnosis between CD and IT.

Methods: Tissue specimens were obtained from 36 patients who were diagnosed with CD or IT by the colonoscopic biopsy, as well as by the clinical findings. The expression of tissue ACE was detected by immunohistochemical staining. The optimal cut-off value of the immunoreactive scoring (IRS) system we used to differentiate CD from IT was determined by analysis of the ROC curve and AUROC.

Results: Granuloma was present in 15 of 19 patients with CD (78.9%) and in 15 of 17 patients with IT (88.2%). ACE was present in the cytoplasm of the epithelioid cells in the granulomas from 13 of 15 patients with CD and in 14 of 15 patients with IT. The IRS scores of ACE were greater in the patients with CD than that of the patients with IT (8.07 +/- 4.38 vs. 4.13 +/- 2.47, respectively, p = 0.006). In differentiating CD from IT, the AUROC curve for the IRS of ACE was 0.767 with a sensitivity of 66.7%, a specificity of 93.3% and the cut-off point was 7.5.

Conclusions: The results of our study suggest that the assessment of the tissue ACE expression can be helpful for making the differential diagnosis between CD and IT.

Citing Articles

Peritoneal sarcoidosis: A case report.

Lee S, Lee M, Lee J, Choi S, Yi B, Jung J Medicine (Baltimore). 2019; 98(24):e16001.

PMID: 31192941 PMC: 6587601. DOI: 10.1097/MD.0000000000016001.

Granulomas as the Most Useful Histopathological Feature in Distinguishing between Crohn's Disease and Intestinal Tuberculosis in Endoscopic Biopsy Specimens.

Ye Z, Lin Y, Cao Q, He Y, Xue L Medicine (Baltimore). 2015; 94(49):e2157.

PMID: 26656343 PMC: 5008488. DOI: 10.1097/MD.0000000000002157.

Association between ACE I/D polymorphism and pulmonary tuberculosis in Chinese population.

Zhang Y, Li X, Wu Z, Fan H Mol Biol Rep. 2014; 41(5):3187-9.

PMID: 24573999 DOI: 10.1007/s11033-014-3178-6.

References

Matsuda T, Suzuki J, Furuya K, Masutani M, Kawakami Y . Serum angiotensin I-converting enzyme is reduced in Crohn's disease and ulcerative colitis irrespective of genotype. Am J Gastroenterol. 2001; 96(9):2705-10. DOI: 10.1111/j.1572-0241.2001.03945.x. View

Amarapurkar D, Patel N, Amarapurkar A, Agal S, Baigal R, Gupte P . Tissue polymerase chain reaction in diagnosis of intestinal tuberculosis and Crohn's disease. J Assoc Physicians India. 2005; 52:863-7. View

Park J, Yang S, Myung S, Byeon J, Lee Y, Lee G . [Clinical characteristics at diagnosis and course of Korean patients with Crohn's disease]. Korean J Gastroenterol. 2004; 43(1):8-17. View

Silverstein E, Friedland J, LYONS H . Serum angiotensin converting enzyme in sarcoidosis: clinical significance. Isr J Med Sci. 1977; 13(10):1001-6. View

Klauser R, Robinson C, Marinkovic D, Erdos E . Inhibition of human peptidyl dipeptidase (angiotensin I converting enzyme: kininase II) by human serum albumin and its fragments. Hypertension. 1979; 1(3):281-6. DOI: 10.1161/01.hyp.1.3.281. View

PERTSCHUK L, Silverstein E, Friedland J . Immunohistologic diagnosis of sarcoidosis. Detection of angiotensin-converting enzyme in sarcoid granulomas. Am J Clin Pathol. 1981; 75(3):350-4. DOI: 10.1093/ajcp/75.3.350. View

Katz P, Fauci A, Yeager Jr H, REEN B . Serum angiotensin-converting enzyme and lysozyme in granulomatous diseases of unknown cause. Ann Intern Med. 1981; 94(3):359-60. DOI: 10.7326/0003-4819-94-3-359. View

SALDEEN T, Ryan J, Berryer P . A peptide derived from fibrin(ogen) inhibits angiotensin converting enzyme and potentiates the effects of bradykinin. Thromb Res. 1981; 23(4-5):465-70. DOI: 10.1016/0049-3848(81)90208-5. View

Grange J, MITCHELL D, Kemp M, Kardjito T . Serum angiotensin-converting enzyme and delayed hypersensitivity in pulmonary tuberculosis. Tubercle. 1984; 65(2):117-21. DOI: 10.1016/0041-3879(84)90063-1. View

10.

Ainslie G, Benatar S . Serum angiotensin converting enzyme in sarcoidosis: sensitivity and specificity in diagnosis: correlations with disease activity, duration, extra-thoracic involvement, radiographic type and therapy. Q J Med. 1985; 55(218):253-70. View

11.

Remmele W, Stegner H . [Recommendation for uniform definition of an immunoreactive score (IRS) for immunohistochemical estrogen receptor detection (ER-ICA) in breast cancer tissue]. Pathologe. 1987; 8(3):138-40. View

12.

Jaszewski R, Tolia V, Ehrinpreis M, Bodzin J, Peleman R, Korlipara R . Increased colonic mucosal angiotensin I and II concentrations in Crohn's colitis. Gastroenterology. 1990; 98(6):1543-8. DOI: 10.1016/0016-5085(90)91088-n. View

13.

Rutgeerts P, Geboes K, VANTRAPPEN G, Beyls J, KERREMANS R, Hiele M . Predictability of the postoperative course of Crohn's disease. Gastroenterology. 1990; 99(4):956-63. DOI: 10.1016/0016-5085(90)90613-6. View

14.

Shah S, Thomas V, Mathan M, Chacko A, Chandy G, Ramakrishna B . Colonoscopic study of 50 patients with colonic tuberculosis. Gut. 1992; 33(3):347-51. PMC: 1373825. DOI: 10.1136/gut.33.3.347. View

15.

Letizia C, DAmbrosio C, Agostini D, Corsi A, Boirivant M, Pallone F . Serum angiotensin converting enzyme activity in Crohn's disease and ulcerative colitis. Ital J Gastroenterol. 1993; 25(1):23-5. View

16.

Brice E, FRIEDLANDER W, Bateman E, KIRSCH R . Serum angiotensin-converting enzyme activity, concentration, and specific activity in granulomatous interstitial lung disease, tuberculosis, and COPD. Chest. 1995; 107(3):706-10. DOI: 10.1378/chest.107.3.706. View

17.

Jayanthi V, Robinson R, Malathi S, Rani B, Balambal R, Chari S . Does Crohn's disease need differentiation from tuberculosis?. J Gastroenterol Hepatol. 1996; 11(2):183-6. DOI: 10.1111/j.1440-1746.1996.tb00058.x. View

18.

Shah S, Miller A, Mastellone A, Kim K, Colaninno P, Hochstein L . Rapid diagnosis of tuberculosis in various biopsy and body fluid specimens by the AMPLICOR Mycobacterium tuberculosis polymerase chain reaction test. Chest. 1998; 113(5):1190-4. DOI: 10.1378/chest.113.5.1190. View

19.

Tan Y, Lee A, Khoo K, Ong S, Wong S, Ong Y . Rapid mycobacterial tuberculosis detection in bronchoalveolar lavage samples by polymerase chain reaction in patients with upper lobe infiltrates and bronchiectasis. Ann Acad Med Singap. 1999; 28(2):205-8. View

20.

Gerhardt T, Wolff M, Fischer H, Sauerbruch T, Reichel C . Pitfalls in the diagnosis of intestinal tuberculosis: a case report. Scand J Gastroenterol. 2005; 40(2):240-3. DOI: 10.1080/00365520410009618. View