Johnson CM, et al. - The relationship between granulomas and Crohn’s disease (CD) severity was investigated over a 6-year time period in a large cohort of patients. Epithelioid granulomas developed in less than 13% of patients with CD. These granulomas were correlated with a more aggressive disease phenotype. An increased risk for repeat surgery within 6 years was evident among patients who underwent surgery for CD and had granulomas.

Methods

• A retrospective study of patients with CD seen at the Inflammatory Bowel Disease Center at the University of Pittsburgh was performed.
• The researchers collected data from 2009 through 2014 and assigned patients to groups with and without histologic evidence of granuloma.
• They used demographic, clinical (including disease activity, quality of life, medication use, and health-care utilization), and laboratory data in association and survival analyses.
• Using the Mann-Whitney U-test for continuous variables, differences between groups were assessed.

Results

• The researchers identified granulomas in 187 patients (12.8%) among the 1,466 patients with CD.
• Granulomas were found in 21.0% in the subset of patients who underwent surgery.
• An association of presence of granuloma was observed with increased serum levels of c-reactive protein (odds ratio [OR], 2.9; 95% CI, 2.078-4.208; P<.0001), younger mean age at diagnosis (23.6±11.3 years in patients with granulomas vs 27.9±13.3 years in patients without; P=.0005), higher rates of stricturing or penetrating disease phenotype, higher rates of steroid and narcotic use, and higher health-care utilization.
• The presence of granulomas was associated with need for repeat surgery during the 6-year observation period (OR, 2.5; 95% CI, 1.54-4.02; P=.0002) among patients that underwent surgery.
• Infliximab use was correlated with detection of granuloma in a significantly lower proportion of surgical specimens than the patients who had not been treated with a biologic agent (OR=0.22; 95 CI, 0.05-0.97; P=.03).