Frequency of epithelioid granulomas in colonoscopic biopsies from pediatric and adult patients with Crohn's colitis

Abstract

Background and Aims: The assumption that epithelioid granulomas found in colonoscopic biopsies in patients with Crohn's colitis (Cr-Cs) are markers of a different clinical behaviour was tested at follow-up.

Methods: Sections from colonoscopic biopsies from 352 consecutive patients (119 children and 233 adults) were investigated.

Results: A total of 1.117 colonoscopies were performed: 293 in children (mean 2.46) and 824 in adults (mean 3.53) (p<0.05). Granulomas at initial colonoscopy were recorded in 67.2%(43/64) of children and in 65.9% (27/41) of adults (p>0.6) and at subsequent colonoscopies in 53.8% (64/119) of children and in 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 or/and in subsequent colonoscopic biopsies in patients with Cr-Cs did not predict the need of subsequent surgical intervention. The fact that the frequency of granulomas was significantly higher in children than in adults with Cr-Cs (despite a higher mean number of colonoscopic biopsies in adults) and that granulomas were present in colonoscopic biopsies but not in the subsequent surgical specimens from 50% of the pediatric and from 36% of the adult patients strengthen the conviction that granulomas in Cr-Cs 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 those in children- when challenged by the so far elusive etiological agent responsible for Crohn's disease.