Fenotipo y curso clínico de la enfermedad de Crohn pediátrica con granulomas: un estudio de cohorte retrospectivo

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Bilge S Akkelle¹, Pinar Ay², Cigdem Celikel³

¹Division of Pediatric Gastroenterology, Hepatology and Nutrition, Marmara University School of Medicine, Istanbul, Turkey.

Pediatric and developmental pathology : the official journal of the Society for Pediatric Pathology and the Paediatric Pathology Society

|February 19, 2026

Abstracto

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.

Palabras clave:

Enfermedad de Crohn exacerbación granuloma pediátrico fenotipo

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