A 26-year-old Indian man undergoes colonoscopy for chronic diarrhea and right iliac fossa pain. Findings under evaluation to distinguish intestinal tuberculosis from Crohn disease. Which single feature most strongly favors intestinal tuberculosis?

• A Longitudinal ulcers along the mesenteric border
• B Cobblestoning of the mucosa
• C Skip lesions with normal intervening mucosa
• D Transverse ulcers perpendicular to the long axis ✓

Explanation

Intestinal tuberculosis characteristically produces transverse ulcers running perpendicular to the bowel long axis because the bacilli spread along lymphatics that circle the gut, whereas Crohn disease produces longitudinal serpiginous ulcers. Caseating confluent granulomas, circumferential strictures, and involvement of few segments also favor tuberculosis. In India, where both diseases are common, exam convention treats transverse ulcers and caseation as the classic discriminators, and antitubercular therapy is often given empirically when differentiation is uncertain.

Reference: Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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