Intestinal tuberculosis is a common disease that is difficult to diagnose as the disease possesses features that are non-specific which is the main cause of late diagnosis and advancement of the complications. The disease usually mimics other disorders of gastrointestinal origin. There are various methods developed to diagnose the condition as early as possible. Furthermore, early diagnosis is a key to success in this disease. Antituberculous therapy initiation even in suspicious cases and surgical intervention is required in order to prevent complications of morbidity and mortality. In this text we shall look into some more detail of Intestinal Tuberculosis and its management available in the contemporary system of medicine as well as Ayurvedic medicine. Let’s have a look at it !!
Tuberculosis is a serious, complicated and life threatening disease which can affect any organ of the body. There are around 12 million cases of tuberculosis worldwide. India is one of the largest hubs of tuberculosis patients as 26 percent of the world’s cases are in India. India is followed by China and South Africa respectively. Tuberculosis is a disease which is rising exponentially. The disease usually affects people who are immunocompromised. The spread of the condition is also aided by overcrowding, drug resistance and poverty. Intestinal Tuberculosis is an extra pulmonary manifestation of tuberculosis. Its incidence is high in HIV infected patients. Tuberculosis can affect any part of the gastrointestinal tract from mouth to the anus. Around 70-78 percent cases of abdominal tuberculosis are gastrointestinal. But most commonly involved sites are ileum, proximal colon and peritoneum. In Ayurveda, the condition can be correlated with rajayakshma and can be pronounced as koshtha gata rajyakshma. Tuberculosis may be compared with Rajayakshma on the basis of features such as kasa, raktavamana, chardi, pratishaya etc and mode of transmission, pathogenesis (samprapti) as per Charaka Samhita (nidan sthana-6 chap) and by Sushruta in his soshapratishedhaadhyaya. There is no clear-cut mention of a gastrointestinal type of tuberculosis. But in AstangaHridaya, Vagbhata divided rajayakshma into various types according to the clinical features.
Causative Agent of Intestinal Tuberculosis
Tuberculosis is caused by Mycobacterium tuberculosis.
Ways the infection is spread
- Hematogenous spread from an active tuberculosis focus
- Lymphatic spread
- Infectious spread from adjacent organ
- Swallowing the food contaminated with Mycobacterium tuberculosis
The organism passes the mucosa and gets settled in the submucosa and an inflammatory process occurs and the granuloma formation occurs. Further inflammation helps in developing sub mucosal and serosal thickening, lymphatic hyperplasia, oedema, mucosal ulceration occurs due to end arteries and thickening of the wall of the gut as a result of post inflammatory fibroblastic reaction.
There are two principal presentations of intestinal tuberculosis:
- Hyperplastic tuberculosis (less common) as a result of ingestion of Mycobacterium tuberculosis by patients with a high resistance to the organism.
- Ulcerative tuberculosis (more common) is secondary to pulmonary tuberculosis and arises as a result of swallowing tubercle bacilli.
Ileocecal region is commonly involved in intestinal tuberculosis due to the rich lymphatics in the peyer’s patches, presence of alkaline media helps in growth of the organisms, stasis due to presence of ileocecal valve and it is the area of maximum absorption.
In the type of gastrointestinal TB 75% of the cases involved the cecum and ileum. Other than this stomach, oesophagus, ascending colon, duodenum, sigmoid colon, jejunum, rectum and appendix involvement are also seen.
1. Ileocecal Tuberculosis
Colicky abdominal pain, obstruction due to narrowed lumen by hyperplastic cecal TB or adhesions, lump may be felt at right iliac fossa, malabsorption, perforation, diarrhoea, gradual weight loss.
2. Segmental colonic
Colonic involvement except the ileocecal region present with hematochezia, bleeding, fever and anorexia.
3. Rectal and Anal Tuberculosis
Constipation, hematochezia, high frequency of rectal bleeding, fistula and ischiorectal abscess.
4. Gastro duodenal Tuberculosis
Gastric outlet obstruction, obstructive type of jaundice, dyspepsias, duodenal ulcer, hematemesis, fistula.
1. Routine blood test
ESR and TLC are high in ulcerative tuberculosis. Haemoglobin may be low, indicating anaemia.
2. Chest X-Ray
It is negative in Hyperplastic tuberculosis whereas Chest X-Ray in ulcerative type reveals pulmonary tuberculosis.
3. Barium study
Shows a long narrow filling defect in the terminal ileum in hyperplastic tuberculosis and in Ulcerative type of tuberculosis barium study and CT scan show absent filling of the lower ileum, caecum and ascending colon as a result of narrowing of the ulcerated segment.
A complete course of ATT (Anti tubercular treatment, DOTS) is advised. Surgery is indicated in case of perforation and obstruction of the intestine.
Adverse Effect of ATT
- Isoniazid: skin rashes, hepatitis
- Rifampicin: abdominal discomfort, nausea, vomiting, hepatitis, thrombocytopenic purpura
- Pyrazinamide: arthralgia, hepatitis
- Streptomycin: vestibular and auditory nerve damage, renal damage
- Ethambutol: retrobulbar neuritis, ocular side effects
- Thioacetazone: skin rash, exfoliative dermatitis
- Para Aminosalicylic acid: anorexia, nausea, vomiting, hypersensitivity reactions
- Kanamycin: vertigo, auditory nerve damage, nephrotoxicity
- Ethionamide: diarrhoea, abdominal pain, hepatotoxicity
- Cycloserine: dizziness, headache, depression, psychosis, convulsions
Tuberculosis is a condition known as rajyakshama in Ayurveda. Rajayakshma is a disease caused by vitiation of all the three doshas i.e. vata, pitta and kapha. Therefore the protocol of managing the condition of koshta gat rajayakshma is based on the pacification of the doshas. Swarn vasant malti ras, praval panchamrit and kamdudha ras are some of the main classical formulations that are considered to be best in Tuberculosis and its extra pulmonary manifestations as well.
Herbal Remedies for Intestinal Tuberculosis by Planet Ayurveda
Planet Ayurveda is an eminent GMP certified, ISO 9001:2015 certified and US-FDA registered Ayurvedic Company, which adhered to the aim of manufacturing quality Ayurvedic products as mentioned in the various ancient texts of Ayurveda. formulations are manufactured without additives and preservatives and other kinds of chemicals or artificial flavouring agents which have a number of side effects on the human body. Products prepared at Planet Ayurveda are pure and do not contain any kind of adulteration. The products are purely organic and vegetarian and gluten free. Planet Ayurveda presents its various products which are beneficial in Intestinal Tuberculosis.
Following is the list of formulations prepared by Planet Ayurveda that are effective in managing the condition of Intestinal Tuberculosis:
- PRAVAL PANCHAMRIT
- KAMDUDHA RAS (MOTI YUKT)
- KANCHNAAR GUGGUL
- PITTA BALANCE
- SWARN VASANT MALTI RAS
- BELGIRI POWDER
1. PRAVAL PANCHAMRIT
It is a classical formulation made up of mukta bhasma (Pearl calx), shankh bhasma (conch shell calx), shukti bhasma (Pearl oyster calx), pravala bhasma (coral calx) and latex of arka (Calotropis procera). The formulation is known for balancing vata and kapha dosha. It is beneficial in a number of gastrointestinal conditions as it relieves a variety of symptoms related to gastrointestinal symptoms including malabsorption. Furthermore, it is useful in the condition of intestinal tuberculosis as it is useful in strengthening the intestines and healing the mucosa of the intestine. Hence, it is a helpful formulation in Intestinal Tuberculosis.
Dosage: Two tablets twice a day with plain water after meals.
2. KAMDUDHA RAS (MOTI YUKT)
Kamdudha Ras (moti yukt) is a classical ayurvedic medicine composed of mukta shukti bhasma (Pearl oyster calx), giloy satva (Tinospora cordifolia), shuddha gairik (red ochre), varatika bhasma (cowries calx), praval bhasma (coral calx), shankh bhasma (conch shell calx) and mukta bhasma (Pearl calx). The formulation balances all the doshas thus it is helpful in intestinal obstruction. It further alleviates all the symptoms associated with intestinal tuberculosis such as hematochezia, bleeding, fever and anorexia.
Dosage: One tablet twice a day after meals with plain water.
3. KANCHNAAR GUGGUL
Kanchnaar guggul is beneficial in intestinal tuberculosis as it reduces the size of the abnormal growth that obstructs the lumen of the gut. It is composed of the herbs that are known to reduce the abnormal sizes of the tissues and reduce pain. Ingredients of the formulation include kachnar bark (Bauhinia variegata), amalaki (Emblica officinale), haritaki (Terminalia chebula), bibhitaki (Terminalia billerica), ginger (Zingiber officinale), marich (Piper nigrum), pippali (Piper longum), varuna bark (Crataeva religiosa), tejapatra (Cinnamomum tamala), guggul (Commiphora mukul) etc. The formulation balances all the vitiated doshas and thus manages the condition of the Intestinal obstruction.
Dosage: Two tablets twice a day with lukewarm water after meals.
4. PITTA BALANCE
Pitta balance is a formulation that balances the pitta dosha as its name suggests. It is a herbomineral formulation which contains jaharmohra, kaharawa, akik, mukta, giloy satva (Tinospora cordifolia). As it manages the vitiated pitta dosha, it also relieves the patient from toxins produced by Mycobacterium tuberculosis. As intestines are seat of pitta dosha and in Intestinal tuberculosis iut gets vuitiated and causes a number of gastrointestinal problems. In order to correct the pitta dosha, Pitta Balance capsules are helpful as it manages all the gastrointestinal problems. Therefore, aiming to manage intestinal tuberculosis one cannot ignore the pacification of pitta dosha.
Dosage: One capsule twice a day with plain water after meals.
5. SWARN VASANT MALTI RAS
It is a herbo-mineral formulation which is enriched with the goodness of various herbs and minerals. The product is composed of shuddha parada (purified mercury), Mukta bhasma (calx of pearl), Swarna bhasma (gold calx), Shuddha hingula (an ore of sulphur and mercury), shuddha gandhak (purified sulphur), trikatu (dried ginger, Black pepper and long pepper), tamra bhasma (copper calx) and loha bhasma (iron calx). Furthermore it contains juice extract of datura (Datura metel), kutki (Picrorhiza kurroa), nimbu swaras (Lemon juice), Kantkari (Solanum xanthocarpum). It is an Ayurvedic choice of formulation for tuberculosis. It boosts immunity which makes the body strong enough to fight a number of infectious agents. Intestinal tuberculosis is mainly seen in immunocompromised patients such as HIV positive cases. Therefore, the condition is managed by Swarn Vasant Malti Ras efficiently. It reduces the infection and as well relieves symptoms of intestinal tuberculosis.
Dosage: One tablet twice a day with honey or butter or pippali churna.
6. BELGIRI POWDER
It is a powder of the bilva (Aegle marmelos). It possesses antidiarrhoeal activity. Therefore it helps in diarrhoea caused by intestinal tuberculosis. It also helps in better absorption of the food thus overcoming weakness caused by the condition. Oit balances the kapha and vata dosha. This helps in overcoming this tridoshaja vyadhi.
Dosage: One tsp twice a day with plain water after meals.
As we discussed interstitial tuberculosis, we came to know that India is the biggest nation worldwide which comprises almost 25% cases of the entire world. Gastrointestinal tuberculosis is a type of extrapulmonary tuberculosis. The causative agent of the condition is Mycobacterium tuberculosis which spreads with various routes. The treatment is Antitubercular treatment as soon as the condition is diagnosed and other supportive care is given as per the condition of the patient. But drugs from the ATT are quite harmful for health. One of the main side effects of the drugs is hepatotoxicity. Therefore, as we have seen the adverse effects of ATT, it becomes obvious and mandatory that one should take proper preventive measures to avoid exposure to this infection. We have also discussed management available for extrapulmonary manifestations of tuberculosis. Above said formulations prepared by Planet Ayurveda are marvellous in managing Intestinal Tuberculosis.