Description of Outcomes of Inflammatory Bowel Disease Patients With Granuloma on Histology: A Single-Center Experience

BACKGROUND: It has been suggested that the presence of granulomas on histologic tissue of patients with Crohn’s disease (CD) is associated with a more aggressive disease phenotype. We sought to investigate the outcomes of patients who had granulomas identified on their tissue histology.

METHODS: This was a retrospective chart review for all inflammatory bowel disease patients who had the word ‘granuloma’ listed on their pathology report, whether from an endoscopic procedure (EGD or colonoscopy) or surgical intestinal resection specimen. We searched reports between 1997 and 2018. All patients who had a gastrointestinal granuloma were identified. Demographic, clinical, and histologic information were obtained from the medical records of these patients.

RESULTS: A total of 41 CD patients were found to have a granuloma identified on their pathology specimen; 8 were found on a surgical resection specimen while 33 were found on endoscopic biopsies. Of the 41 patients, 53.7% were males, 41.7% were smokers, and the average age at CD diagnosis of these patients was 32 ± 15 years. The most common site for granuloma detection was the ileum accounting for 23 cases (56%). A total of 13 patients had granulomas present in more than one site/location (31.7%). The median C-reactive protein within 2 weeks of colonoscopy was 16.5 mg/L; IQR 2.9-58 (normal <2.5 mg/L), median erythrocyte sedimentation rate was 25 mm/hr; IQR 15-45 (normal 17.5 mm/hr), and median hemoglobin was 12g/dL; IQR 10.3-13.6 (normal 12.5g/dL). Of the 41 CD patients with granulomas, 42.5% were on a biologic agent, 41% on an immunomodulatory drug, and 20% had received a steroid at any time for their disease. Moreover, 24.3% had stricturing disease, 15.2% had a history of an intra-abdominal abscess, and 13.9% had a history of peri-anal disease. A total of 32.5% of granuloma CD patients had an intestinal resection and 34% had a CD related hospitalization.

CONCLUSION(S): We suspect that granuloma patients have a more aggressive disease course. The results demonstrate that CD patients with granulomas have higher levels of inflammatory markers and lower hemoglobin. The rates of hospitalizations and need for intestinal resection approached a third of patients with granulomas.