Significance of the epithelioid granuloma in biopsies of crohn's colitis

Kevin Turner, Robert M. Genta, Giovanni Lujan, Cristian Robiou, Amnon Sonnenberg

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: The relevance of granulomas in biopsy specimens from patients with Crohn's disease is largely unknown. Most previous studies have been performed on small samples and have produced conflicting results. This study was designed to compare the demographic, clinical, and histopathologic characteristics of a large cohort of documented patients with Crohn's disease with and without epithelioid granulomas. Methods: Data of all patients with Crohn's disease were extracted from a computerized database of 1.3 million subjects who underwent colonoscopy and had their biopsy specimens diagnosed by a single group of gastrointestinal pathologists. The influence of age, gender, patient symptoms, and histopathologic finding on the presence of granuloma was analyzed. Results: There were 10,456 patients with Crohn's disease: 952 (9%) patients harbored granulomas (cases) and 9504 (91%) patients (controls) had none. Cases were significantly younger than controls: 42.4 6 17.9 versus 48.0 6 16.4 years (P , 0.0001). Cases presented with more symptoms than controls (odds ratio, 95% confidence interval): diarrhea (2.29, 2.28-2.31), anemia (2.06, 2.02-2.10), vomiting (2.13, 2.07-2.19), abdominal pain (1.75, 1.72- 1.78), hematochezia (1.97, 1.94-2.00), and weight loss (3.94, 3.93-3.94). In a multivariate logistic regression analysis, younger age, presence of chronic active colitis, and symptoms of weight loss remained independent statistically significant predictors for the presence of granulomas. Conclusions: In colonic biopsies from patients with Crohn's disease, granulomas constitute a rare finding. Presence of granulomas is associated with younger patient age, more severe histopathologic expression of the underlying disease, and more clinical symptoms.

Original languageEnglish (US)
Pages (from-to)2271-2275
Number of pages5
JournalInflammatory Bowel Diseases
Volume20
Issue number12
DOIs
StatePublished - Dec 1 2014

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Colitis
Granuloma
Biopsy
Crohn Disease
Weight Loss
Gastrointestinal Hemorrhage
Colonoscopy
Abdominal Pain
Vomiting
Anemia
Diarrhea
Logistic Models
Odds Ratio
Regression Analysis
Demography
Databases
Confidence Intervals

Keywords

  • Colonoscopy
  • Epidemiology
  • Histopathology
  • Natural history

ASJC Scopus subject areas

  • Gastroenterology
  • Immunology and Allergy

Cite this

Significance of the epithelioid granuloma in biopsies of crohn's colitis. / Turner, Kevin; Genta, Robert M.; Lujan, Giovanni; Robiou, Cristian; Sonnenberg, Amnon.

In: Inflammatory Bowel Diseases, Vol. 20, No. 12, 01.12.2014, p. 2271-2275.

Research output: Contribution to journalArticle

Turner, Kevin ; Genta, Robert M. ; Lujan, Giovanni ; Robiou, Cristian ; Sonnenberg, Amnon. / Significance of the epithelioid granuloma in biopsies of crohn's colitis. In: Inflammatory Bowel Diseases. 2014 ; Vol. 20, No. 12. pp. 2271-2275.
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abstract = "Background: The relevance of granulomas in biopsy specimens from patients with Crohn's disease is largely unknown. Most previous studies have been performed on small samples and have produced conflicting results. This study was designed to compare the demographic, clinical, and histopathologic characteristics of a large cohort of documented patients with Crohn's disease with and without epithelioid granulomas. Methods: Data of all patients with Crohn's disease were extracted from a computerized database of 1.3 million subjects who underwent colonoscopy and had their biopsy specimens diagnosed by a single group of gastrointestinal pathologists. The influence of age, gender, patient symptoms, and histopathologic finding on the presence of granuloma was analyzed. Results: There were 10,456 patients with Crohn's disease: 952 (9{\%}) patients harbored granulomas (cases) and 9504 (91{\%}) patients (controls) had none. Cases were significantly younger than controls: 42.4 6 17.9 versus 48.0 6 16.4 years (P , 0.0001). Cases presented with more symptoms than controls (odds ratio, 95{\%} confidence interval): diarrhea (2.29, 2.28-2.31), anemia (2.06, 2.02-2.10), vomiting (2.13, 2.07-2.19), abdominal pain (1.75, 1.72- 1.78), hematochezia (1.97, 1.94-2.00), and weight loss (3.94, 3.93-3.94). In a multivariate logistic regression analysis, younger age, presence of chronic active colitis, and symptoms of weight loss remained independent statistically significant predictors for the presence of granulomas. Conclusions: In colonic biopsies from patients with Crohn's disease, granulomas constitute a rare finding. Presence of granulomas is associated with younger patient age, more severe histopathologic expression of the underlying disease, and more clinical symptoms.",
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AB - Background: The relevance of granulomas in biopsy specimens from patients with Crohn's disease is largely unknown. Most previous studies have been performed on small samples and have produced conflicting results. This study was designed to compare the demographic, clinical, and histopathologic characteristics of a large cohort of documented patients with Crohn's disease with and without epithelioid granulomas. Methods: Data of all patients with Crohn's disease were extracted from a computerized database of 1.3 million subjects who underwent colonoscopy and had their biopsy specimens diagnosed by a single group of gastrointestinal pathologists. The influence of age, gender, patient symptoms, and histopathologic finding on the presence of granuloma was analyzed. Results: There were 10,456 patients with Crohn's disease: 952 (9%) patients harbored granulomas (cases) and 9504 (91%) patients (controls) had none. Cases were significantly younger than controls: 42.4 6 17.9 versus 48.0 6 16.4 years (P , 0.0001). Cases presented with more symptoms than controls (odds ratio, 95% confidence interval): diarrhea (2.29, 2.28-2.31), anemia (2.06, 2.02-2.10), vomiting (2.13, 2.07-2.19), abdominal pain (1.75, 1.72- 1.78), hematochezia (1.97, 1.94-2.00), and weight loss (3.94, 3.93-3.94). In a multivariate logistic regression analysis, younger age, presence of chronic active colitis, and symptoms of weight loss remained independent statistically significant predictors for the presence of granulomas. Conclusions: In colonic biopsies from patients with Crohn's disease, granulomas constitute a rare finding. Presence of granulomas is associated with younger patient age, more severe histopathologic expression of the underlying disease, and more clinical symptoms.

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