[Changes in the ileal mucosa in Crohn disease. Endoscopic and histologic study]

In 383 patients, suffering from Crohn's disease, ileum was studied both endoscopically and histologically. In patients without surgical interventions (n = 207), endoscopic lesions were observed in 69%, histologic lesions in 74%. Most numerous endoscopic lesions were redness (51%), vulnerability (29%) and ulcer (27%), most frequent histologic lesions discontinuous infiltration (30%) and ulcer (30%). In patients, operated on, endoscopic and histologic lesions were found more often in the ileal region, near to anastomosis than in the more proximal ileum. Overall, the endoscopic and histologic appearance of the distal segment of the ileum widely corresponded to that of the terminal ileum in patients without surgery. Several endoscopic parameters were correlated to histologic variables, but overall the correlation was low (maximal correlation coefficient 0.34). Granulomas were present in 7.4% of the biopsies and 9.1% of the patients. The occurrence was significantly correlated to the endoscopic variables cobblestone appearance and ulcer as well as to the histologic variables density of infiltration, ulcer, and activity of inflammation. In conservatively treated patients, the incidence of mucosal vulnerability, and cobblestone appearance significantly declined in long standing disease, the incidence of stenosis increased. In patients operated on, aphthous lesions and ulcers increased in longstanding disease.