Supplemental Material for: Unmasking Gastric Tuberculosis: A Systematic Review of 120 Cases. Desvendando a Tuberculose Gástrica: Uma Revisão Sistemática de 120 Casos

Methods

A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Embase, and Google Scholar were searched for English-language case reports and case series published up to April 2026. A total of 120 cases from 98 articles were included.

Data regarding demographics, clinical features, investigations, management, and outcomes were extracted and analyzed.</p><p dir="ltr">Results: Most patients were young adults (20–40 years) with a male predominance (59%). Abdominal pain (76%), weight loss (63%), and vomiting (47%) were the most common symptoms. Diagnosis was frequently delayed, with a median symptom duration of 105 days, and 21% were initially misdiagnosed as peptic ulcer disease.

Endoscopy revealed ulcers (42%) and mass-forming lesions (41%), predominantly in the antrum and pylorus. Microbiological confirmation was limited (50%), while histopathology demonstrated granulomas in the majority. Endoscopic ultrasound-guided tissue acquisition provided additional diagnostic information, particularly in patients with submucosal or mass-forming lesions.

Surgical intervention was required in 49/120 (41%) cases, primarily for complications. Anti-tubercular therapy (ATT) was administered to 112 patients (93.3%). Overall, 117 of 120 patients (97.5%) had a favourable outcome, while three patients died in the postoperative period.</p><p dir="ltr">Conclusion: Gastric TB is a rare but important differential diagnosis in patients with chronic upper gastrointestinal symptoms, particularly in endemic regions.

A multimodal diagnostic approach incorporating deep biopsies, endoscopic ultrasound, and molecular techniques improves diagnostic accuracy. Early initiation of ATT leads to excellent outcomes and reduces the need for surgery.</p>