Treatment Response of Pulmonary Tuberculosis in Patients who received Gastrectomy = Treatment Response of Pulmonary Tuberculosis in Patients who received Gastrectomy

다국어 초록 (Multilingual Abstract)

Background: Gastrectomy is a significant risk factor for development of pulmonary tuberculosis. However, only limited data is known about the course and treatment outcome of pulmonary tuberculosis (Pul TB) in patients who have received gastrectomy. Therefore, the aim of this study is to identify the clinical and microbiological treatment response of pulmonary tuberculosis in patients who have received gastrectomy. Methods: We conducted a retrospective case-control study involving 15 Pul TB cases with gastrectomy and 45 age-matched Pul TB controls (1: 3 matched) without gastrectomy between January 2005 and December 2014 in a 2000-bed tertiary care hospital in South Korea. Only culture proven Pul TB cases were enrolled. Microbiological and clinical failures werecompared between the groups. Microbiological failure was defined as positive AFB smear or culture after 4 months. Clinical treatment failure was defined as no improvement on chest x-ray or chest CT after 4 months. Results: The median age was 64.2 years inthe control group, and 64.5 years in the gastrectomy group. As for sex, 21 (46.7%) patients were male in the control group and 13 (86.7%) patients in the gastrectomy group. 2 months sputum AFB or culture positive was seen in 3 (20.0%) patients in the gastrectomy group and 5 (11.1%) in the control group (p＝0.400). 4 months sputum AFB or culture positive was seen in 2 (13.3%) patients in the gastrectomy group and 0 (0%) patient in the control group (p＝0.059). No improvement in 2 months chest x-ray or chest CT was seen in 4 (26.7%) patients in the gastrectomy group and 2 (4.4%) in the control group (p＝0.030). No improvement in 4 months chest x-ray or chest CT was seen in 4 (26.7%) patients in the gastrectomy group, and 0 (0%) in the control group (p＝0.003). The frequency of severe gastrointestinal adverse events by anti-TB medications was more frequent in the gastrectomy group 9 (60%) compared to the control 3 (6.7%, p＝0.001). Conclusions: Patients who received gastrectomy prior to Pul TB treatment were at significantly higher risk of clinical treatment failure and gastrointestinal adverse events.