Clinical Significance of Granulomas in Crohn's Disease: A Systematic Review and Meta-analysis

Seung Wook Hong, Hyuk Yoon, Cheol Min Shin, Young Soo Park, Nayoung Kim, Dong Ho Lee, Joo Sung Kim
Journal of Gastroenterology and Hepatology 2019 September 14

BACKGROUND AND AIM: Epithelioid granuloma is one hallmark used to histologically diagnose Crohn's disease (CD). However, the clinical significance of granulomas in CD is unclear. Therefore, we performed a meta-analysis to compare the clinical features with CD according to the presence of granulomas.

METHODS: A literature search in PubMed, EMBASE, and Cochrane databases was performed on manuscripts published until Oct 2018. We included studies that met the following inclusion criteria; (1) patient: patients with CD; (2) exposure: granulomas on the pathology; (3) comparator: no granulomas; (4) outcomes: disease location, disease behaviour, perianal disease, disease activity, use of biologics, and CD-associated hospitalization, surgery.

RESULTS: Nineteen studies met our inclusion criteria. Granulomas in CD patients were associated with a higher proportion of ileocolonic disease (odds ratio [OR] 1.49, 95% confidence interval [CI]: 1.21-1.83), a higher proportion of upper gastrointestinal disease (OR: 2.25, 95% CI: 1.28-3.95), a higher proportion of penetrating behaviour (OR: 1.48, 95% CI: 1.09-2.01), a higher prevalence of perianal disease (OR: 2.15, 95% CI: 1.48-3.11) and a higher severity index at presentation (standardized mean difference [SMD]: 0.20, 95% CI: 0.09-0.32). In addition, use of biologics was significantly higher in CD patients with granulomas compared to without granulomas (OR: 1.66, 95% CI: 1.07-2.59). The presence of granulomas was significantly associated with CD-associated hospitalization (OR: 3.88, 95% CI: 1.44-10.49), but not with CD-associated surgery.

CONCLUSIONS: Clinical features in CD patients were significantly different according to the presence of granulomas. It may indicate a more aggressive phenotype of CD.


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