Diagnostic Significance of Epithelioid Granulomas in Crohnʼs Disease in Children

Km, Keller; Sw, Bender; Kirchmann, H; Ball, F; Schmitz-Moormann, P; Wirth, S.; Baumann, Wolfram

doi:10.1097/00005176-199001000-00005

Cited by 22 publications

(13 citation statements)

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“…Epithelioid granulomas are highly specific for CD, as is noted in much of the literature, 8,16,22,24,27–31 and have been stressed to be sufficiently reproducible 19,23,24 . Out of 11 CD sets with epithelioid granulomas, only one to four sets had values for the CD score below 1.0 when analyzing the data from the five observers.…”

Section: Discussionmentioning

confidence: 86%

Observer variation of diagnoses based on simple biopsy criteria differentiating among Crohn's disease, ulcerative colitis, and other forms of colitis

Tanaka

Matsumoto

Yao

et al. 2001

J of Gastro and Hepatol

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Section: Discussionmentioning

confidence: 86%

Observer variation of diagnoses based on simple biopsy criteria differentiating among Crohn's disease, ulcerative colitis, and other forms of colitis

Tanaka

Matsumoto

Yao

et al. 2001

J of Gastro and Hepatol

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“…Table 3 shows that the frequency of granulomas present in tissue sections varies in different publications, from 7%27 to 100% 19. One confounding factor for this variation may be that some series include only children,23 27 others both children and adolescents,26 others both children and adults,13–18 24 25 28 29 and others only adults 10 19 20 30 31.…”

Section: Discussionmentioning

confidence: 99%

“…However, from table 3, it may be deduced that in some series, the frequency of granulomas in CD was higher in adults than in children. Another confounding factor may be differences in the quantity of tissue investigated by the various pathologists: some series include only rectal biopsies,20 21 27 28 others recto-sigmoidoscopic biopsies,26 other colonoscopic biopsies,10 12 13 23 28 and others only sections from surgical specimens 14–19 25 29 31…”

Section: Discussionmentioning

confidence: 99%

Frequency of epithelioid granulomas in colonoscopic biopsy specimens from paediatric and adult patients with Crohn’s colitis

et al. 2007

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Aims: To test the assumption that epithelioid granulomas found in colonoscopic biopsy specimens in patients with Crohn's colitis are markers of a different clinical behaviour. Methods: Sections from colonoscopic biopsy specimens from 352 consecutive patients (119 children and 233 adults) were investigated. Results: A total of 1117 colonoscopies were performed: 293 in children (mean 2.46 per patient) and 824 in adults (mean 3.53 per patient) (p,0.05). Granulomas at initial colonoscopy were recorded in 67.2% (43/ 64) of children and 65.9% (27/41) of adults (p.0.6), and at subsequent colonoscopies in 53.8% (64/119) of children and 17.6% (41/233) of adults (p,0.05). Surgical intervention was required in 6.3% (4/64) of the children having previous granuloma, but also in 14.5% (8/55) of those without previous granuloma, the rate for operated adults being 26.8% (11/41) and 24.5% (47/192), respectively (p.0.6). Conclusions: Granulomas in entry and/or in subsequent colonoscopic biopsy specimens in patients with Crohn's colitis did not predict the need for subsequent surgical intervention. The fact that the frequency of granulomas was significantly higher in children than in adults with Crohn's colitis (despite a higher mean number of colonoscopic biopsies in adults), and that granulomas were present in colonoscopic biopsy specimens but not in the subsequent surgical specimens from 50% of the paediatric and 36% of the adult patients strengthen the conviction that granulomas in Crohn's colitis might evolve or regress at different time intervals during the course of the disease. This behaviour would reflect a particular immunological reaction, an epiphenomenon from immature tissues-as in children-when challenged by the so far elusive aetiological agent responsible for Crohn's disease.

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“…In contrast, colonic goblet cells are usually intact in CD, and the mononuclear infiltrate of the mucosa shows mainly T cells and monocytic cells. Granulomas, which are characteristic for CD, are detected in the resection specimen in only 40-60% of the cases and much less frequently in biopsy samples (15-36%) [39,40]. Another classical discriminator, the transmural (CD) versus the mucosal inflammation (UC), requires operative specimens, whereas colonic biopsies should not extend beyond the lamina propria.…”

Section: Apparative Diagnosticsmentioning

confidence: 99%

New pathophysiological insights and modern treatment of IBD

2010

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Inflammatory bowel disease (IBD), which comprises two main types, namely, Crohn's disease and ulcerative colitis, affects approximately 3.6 million people in the USA and Europe, and an alarming rise in low-incidence areas, such as Asia, is currently being observed. In the last decade, spontaneous mutations in a diversity of genes have been identified, and these have helped to elucidate pathways that can lead to IBD. Animal studies have also increased our knowledge of the pathological dialogue between the intestinal microbiota and components of the innate and adaptive immune systems misdirecting the immune system to attack the colon. Present-day medical therapy of IBD consists of salicylates, corticosteroids, immunosuppressants and immunomodulators. However, their use may result in severe side effects and complications, such as an increased rate of malignancies or infectious diseases. In clinical practice, there is still a high frequency of incomplete or absent response to medical therapy, indicating a compelling need for new therapeutic strategies. This review summarizes current epidemiology, pathogenesis and diagnostic strategies in IBD. It also provides insight in today's differentiated clinical therapy and describes mechanisms of promising future medicinal approaches.

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Diagnostic Significance of Epithelioid Granulomas in Crohnʼs Disease in Children

Cited by 22 publications

References 0 publications

Observer variation of diagnoses based on simple biopsy criteria differentiating among Crohn's disease, ulcerative colitis, and other forms of colitis

Observer variation of diagnoses based on simple biopsy criteria differentiating among Crohn's disease, ulcerative colitis, and other forms of colitis

Frequency of epithelioid granulomas in colonoscopic biopsy specimens from paediatric and adult patients with Crohn’s colitis

New pathophysiological insights and modern treatment of IBD

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