Intestinal Tuberculosis: Symptoms, Diagnosis, and Treatment

Yes — TB most often affects the lungs, but it can also settle in the intestines, and this form is called abdominal or intestinal TB. It usually reaches the gut when swallowed sputum from a lung infection carries bacteria into the digestive tract, or when bacteria spread through the bloodstream. The ileocecal region (where the small intestine meets the large intestine) is the most common site. Intestinal TB accounts for a large share of extrapulmonary TB cases and can occur even when the chest X-ray looks normal, so it's often missed at first. Diagnosis requires a strong clinical suspicion, especially in anyone with unexplained chronic abdominal pain, weight loss and low-grade fever.

Chronic abdominal pain, weight loss, low-grade evening fever and altered bowel habits are the most common symptoms. Pain is usually dull and centred around the right lower abdomen. Patients may notice bloating, loose stools alternating with constipation, loss of appetite and night sweats. As the disease progresses, some develop a palpable lump in the abdomen (from thickened bowel loops), signs of bowel obstruction (vomiting, distension) or ascites (fluid in the abdomen). Because the symptoms mimic conditions like Crohn's disease, IBS, ovarian problems and even lymphoma or colorectal cancer, delays in diagnosis of several months are common. Persistent unexplained abdominal symptoms with weight loss should always prompt investigation for TB in high-prevalence settings.

The most reliable diagnosis comes from a colonoscopy with biopsy of the ileocecal region. On colonoscopy the doctor looks for characteristic ulcers (often transverse), nodules, strictures or a deformed ileocecal valve. Biopsies are sent for histopathology (looking for granulomas), Ziehl-Neelsen stain (to visualise the bacteria), TB culture and molecular tests like GeneXpert MTB/RIF (which also detects rifampicin resistance in hours). A contrast CT scan of the abdomen helps show bowel wall thickening, enlarged lymph nodes, ascites and complications. Chest X-ray is done to check for lung involvement. Blood tests (ESR, IGRA) support the diagnosis but cannot confirm it on their own — tissue evidence is what settles the case.

Intestinal TB is treated with the standard four-drug anti-TB regimen — isoniazid, rifampicin, ethambutol and pyrazinamide — usually for six months in total. The first two months use all four drugs (intensive phase), followed by four months on isoniazid and rifampicin (continuation phase). Some doctors extend treatment to nine or twelve months when there is extensive disease or slow response. Most patients feel dramatically better within four to six weeks. Surgery is reserved for complications such as bowel obstruction that doesn't settle with medicine, perforation, fistulae or severe bleeding. Adherence to the full course is essential — stopping early is the single biggest driver of relapse and drug-resistant TB.