Abdominal tuberculosis (TB) is an important public health problem in developing countries. Because of overlap in the signs and symptoms of the chronic mycobacterial diseases like intestinal tuberculosis (ITB), Crohn's disease (CD), ulcerative colitis, and other inflammatory diseases, there is a need to arrive at a specific diagnosis. Several investigations like computed tomography scan, different endoscopy procedures, ascitic fluid adenosine deaminase (ADA), tuberculosis polymerase chain reaction (TB-PCR), GeneXpert, laparoscopy, etc., are being increasingly used to diagnose TB. Advances in imaging methods and direct access to affected sites by endoscopy have made significant contribution in improving the diagnosis. A combined evaluation of clinical features, endoscopy, histology, and response to treatment has been recommended to differentiate between CD and ITB. Various studies show that clinical features and histopathology, especially granuloma characteristics, have a major role in moving toward specific diagnosis of these conditions. Development of a large number of probes and gene amplification (different variants of PCR and isothermal methods) for TB and other mycobacteria has provided very powerful tools. If used properly they can significantly help in arriving at specific diagnosis of chronic mycobacterial diseases of intestinal tract. Detection of mycobacterial genetic/antigenic components in biopsies by in situ hybridization (ISH), in situ PCR, and immunohistochemistry (IHC) has been observed to be quite useful in differentiating ITB from CD. A number of newer methods based on expression of angiotensin converting enzyme (ACE), aptamers and biosensors have already appeared on the horizon and have potential diagnostic as well as therapeutic value for various forms of TB including abdominal TB. While many of these approaches/techniques have shown promise, they have not been adequately studied to become part of diagnostic strategy for clinical settings in countries like India.