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The Phenotype and Clinical Course of Pediatric Crohn's Disease With Granulomas: A Retrospective Cohort Study
Bilge S Akkelle1, Pinar Ay2, Cigdem Celikel3
1Division of Pediatric Gastroenterology, Hepatology and Nutrition, Marmara University School of Medicine, Istanbul, Turkey.
Insights
Granulomas in pediatric Crohn's disease (CD) indicate a more extensive disease phenotype and are linked to a more aggressive clinical course, including earlier exacerbations and increased risk of fistulizing perianal disease.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Pathology
- Inflammatory Bowel Disease Research
Background:
- The clinical significance of granulomas in pediatric-onset Crohn's disease (CD) remains unclear.
- Understanding granuloma's role is crucial for predicting disease course and optimizing treatment in young CD patients.
Purpose of the Study:
- To investigate the association between granulomas and the phenotype of pediatric CD.
- To analyze the clinical course and long-term outcomes in pediatric CD patients with and without granulomas.
Main Methods:
- Retrospective analysis of histopathological findings from 317 endoscopic procedures in 81 pediatric CD patients.
- Comparison of disease phenotype and clinical follow-up data between patients with and without granulomas detected in biopsies.
Main Results:
- Granulomas were present in 39.5% of pediatric CD patients at diagnosis.
- Granuloma presence correlated with ileocolonic disease, upper GI involvement, and moderate-severe disease activity.
- Granulomas were associated with earlier exacerbations and a higher incidence of fistulizing perianal disease.
Conclusions:
- Granulomas in pediatric CD are linked to a distinct, extensive disease phenotype.
- Granulomas may serve as a predictor of aggressive disease progression in pediatric CD.
- The presence of granulomas could influence treatment strategies for pediatric Crohn's disease.
Objectives:
The significance of granulomas has still not been clarified in pediatric onset Crohn's disease (CD). The aim of this study was to investigate the phenotype and clinical course in CD patients with granuloma in a comprehensive cohort.
Materials And Methods:
Histopathological findings of 317 endoscopic procedures of 81 pediatric CD patients were retrospectively analyzed. The phenotype of the patients and long-term follow-up data were compared in patients with and without granuloma.
Results:
At diagnosis, granuloma was detected in at least 1 biopsy in 39.5% of the patients. Patients with granuloma had significantly higher rate of ileocolonic disease, upper gastrointestinal involvement (68.7% vs 36.7%) and moderate-severe activity at diagnosis compared to patients without granuloma. In multivariate analysis, the presence of granulomas was associated with an increased risk of exacerbation (HR = 1.52; 95% CI: 0.83-2.75; P > .05). Patients with granuloma experienced earlier exacerbation and developed fistulizing perianal disease more frequently (P = .02) and significantly earlier (P = .002) than patients without granulomas.
Conclusions:
Our results suggest that granulomas were associated with a distinct phenotype characterized by extensive involvement. Considering the clinical course, it is thought that granulomas may be a predictor of aggressive disease course and potential modifier of treatment strategy.
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