Gastrointestinal tuberculosis: An autopsy-based study

Comparative Study on the Prokinetic Effects of Ginger, Caraway, and Peppermint in Relieving Gastrointestinal Disturbances in Pulmonary TB Patients: A Clinical Trial

Anti-tuberculosis treatment (ATT) leads to adverse gastrointestinal disturbances (vomiting, nausea, postprandial distress) due to its prolonged duration in TB patients. This study assessed the prokinetic effects of ginger, caraway, and peppermint nutraceuticals in alleviating these symptoms in pulmonary TB patients on ATT. The selected nutraceuticals were procured, cleaned, dried, and crushed to perform proximate analysis, TPC, TFC, DPPH, ABTS, and FRAP. Further, a randomized clinical trial (Registered No. NCT06157034) involved 200 participants divided into four groups (placebo = 48, ginger = 47, caraway = 48, peppermint = 46), with 11 dropouts. Participants received varied dosages of selected nutraceuticals (Ginger: 1 g, Caraway: 2 g, and Peppermint: 3 mL daily), and data were collected at baseline, intervention (after 3 months), and washout (after 1 month) phases. Ginger and peppermint showed the highest moisture content (81.67%, 81.74%), while caraway had the highest protein (29.72%) and crude fiber (45.11%). Peppermint had the highest crude fat (54.47%) and crude fiber (4.81%). Moreover, ginger had the highest TPC (1035.51 mgGAE/g) and TFC (465.34 mgQE/g), with notable DPPH, FRAP, and ABTS values. Participants had a mean age (39.03 years), family income (17,385 ± 528.72Rs), and BMI (19.43 ± 5.67). Sputum testing and other biochemical analyses were also done. Energy and macronutrient consumption did not differ significantly across all phases (p > 0.05). The hierarchical heatmap graph depicted the intensity/severity of relieving gastrointestinal disturbances with the consumption of nutraceuticals. Thus, the results concluded that both ginger and peppermint groups, particularly during the washout phase, showed a promising reduction in GI disturbances, suggesting their potential as adjunctive therapy for TB patients on ATT.

Recognizing and addressing the challenges of gastrointestinal tuberculosis

In this editorial, we comment on the article by Ali et al published in the recent issue of the World Journal of Clinical Cases. This case report shed light on a particularly rare manifestation of this disease-primary gastrointestinal tuberculosis (GTB) presenting as gastric outlet obstruction. GTB presents diagnostic challenges due to its nonspecific symptoms and lack of highly accurate diagnostic algorithms. This editorial synthesizes epidemiological data, risk factors, pathogenesis, clinical presentations, diagnostic methods, and therapies to raise awareness about GTB. GTB constitutes 1%-3% of all tuberculosis cases globally, with 6%-38% of patients also having pulmonary tuberculosis. Pathogenesis involves various modes of Mycobacterium tuberculosis complex entry into the gastrointestinal system, with the terminal ileum and ileocecal valve commonly affected. Clinical presentation varies, often resembling other intra-abdominal pathologies, necessitating a high index of suspicion. Diagnostic tools include a combination of biochemical, microbiological, radiological, and endoscopic assessments. Anti-tubercular medication remains the cornerstone of treatment, supplemented by surgical intervention in severe cases. Multidisciplinary management involving gastroenterologists, surgeons, pulmonologists, and infectious disease specialists is crucial for optimal outcomes. Despite advancements, timely diagnosis and management challenges persist, underscoring the need for continued research and collaboration in addressing primary GTB.