Hong SW, Yoon H, Shin CM, et al. - Given that epithelioid granuloma is one hallmark used to histologically diagnose Crohn's disease (CD), however, the clinical significance of granulomas in CD is not clear, researchers compared the clinical characteristics with CD according to the presence of granulomas. Studies that met the following inclusion criteria were included: patient: patients with CD; exposure: granulomas on the pathology; comparator: no granulomas; outcomes: disease location, disease behaviour, perianal disease, disease activity, use of biologics, and CD-associated hospitalization, surgery. Nineteen studies fulfilled the requirements for incorporation. In CD patients, granulomas were linked to a higher proportion of ileocolonic disease, a higher proportion of upper gastrointestinal disease, a higher proportion of penetrating behaviour, a higher prevalence of perianal disease and a higher severity index at presentation. Furthermore, the use of biologics in CD patients with granulomas was significantly higher vs those without granulomas. The presence of granulomas was significantly linked to hospitalization associated with CD, but not to surgery associated with CD. According to the presence of granulomas, clinical features in CD patients were significantly different. A more aggressive CD phenotype may be indicated.