The detection rate of granulomas differs between intestinal segments and lesions in Chinese patients with Crohn's disease - 02/02/23

Doi : 10.1016/j.clinre.2023.102076

Lin-Teng Chen ^a, Jin-Yan Zhang ^a,^b, Jian-Wei Zheng ^b, Juan Yu ^b, Yi Ding ^c, Wei-Lin Yang ^d, Hua Li ^a,^b,^⁎ , Wei-Feng Huang ^a,^b,^⁎
^a The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
^b Department of Gastroenterology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
^c Department of Pathology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
^d Endoscopy center, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China

^⁎Corresponding author at: The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.The School of Clinical Medicine, Fujian Medical UniversityFuzhouChina^⁎⁎Corresponding author at: The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.The School of Clinical Medicine, Fujian Medical UniversityFuzhouChina

Highlights

•	What is already known on this subject?
•	Non-caseating granulomas are a hallmark histologic finding for the diagnosis of Crohn's disease. But the detection rate of granulomas at endoscopy was low.
•	What are the new findings?
•	The detection rate of granulomas differs between intestinal segments and lesions in patients with Crohn's disease.
•	How might it impact on clinical practice in the foreseeable future?
•	The research may help to improve the detection rate of granulomas in clinical practice.

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Abstract

Background

Crohn's disease (CD) is characterized by non-caseating intestinal granulomas. However, the reported detection rate of granulomas on endoscopy is low. This study aimed to analyze the differences in the detection rate of granulomas in different intestinal segments and lesions in Chinese patients with CD to improve the detection rate of granulomas in clinical practice.

Patients and methods

113 patients with CD were analyzed retrospectively. Patients were divided into two groups: those with (n = 51) and without granulomas (n = 62) on endoscopic biopsies. Clinical information was collected from the medical records, including age; erythrocyte sedimentation rate (ESR); C-reactive protein (CRP), albumin, and hemoglobin (Hb) levels; platelet count; disease course; sex; smoking history; related operation history; Montreal classification; and lesion location, size, and shape.

Results

The detection rates of granulomas in different lesion shapes were significantly different (P < 0.001), with those of longitudinal ulcers and circular ulcers being higher than those of erosion and irregular ulcers. We also found that the detection rates of granulomas in ascending colon and sigmoid colon were relatively higher than other segments of the intestine, however, the difference was not statistically significant (P = 0.716). Additionally, age, sex, smoking history, Montreal classification, related surgical history, disease course, and serum biochemical indicators (ESR; platelet count; and CRP, albumin, and Hb levels) were not significantly different between the two groups.

Conclusions

The detection rate of granulomas in patients with CD is related to the morphology of the intestinal lesions. Meanwhile, lesion location may be correlated with the detection rate of granulomas.

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Keywords : Granuloma, Detection rate, Crohn's disease, Endoscopic biopsy, Ulcer