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Granulomas on biopsy and severity of Crohn's disease

Lady Organic

Staff member
''Epithelioid Granulomas Associate with Increased Severity and Progression of Crohn's Disease, Based on 6-year Follow Up.''



Epithelioid granulomas are characteristics of a subset of patients with Crohn's disease (CD), but their significance, with regard to disease progression and severity, is unclear. We investigated the relationship between granulomas and CD severity over a 6-year time period in a large cohort of patients.


We performed a retrospective study of patients with CD seen at the Inflammatory Bowel Disease Center at the University of Pittsburgh; data were collected from 2009 through 2014 and patients were assigned to groups with and without histologic evidence of granuloma. Demographic, clinical (including disease activity, quality of life, medication use, and healthcare utilization), and laboratory data were used in association and survival analyses. Differences between groups were evaluated using the Mann-Whitney U-test for continuous variables.


Of 1466 patients with CD, granulomas were identified in 187 (12.8%). In the subset of patients who underwent surgery, 21.0% had granulomas. The presence of granuloma was associated with increased serum levels of c-reactive protein (odds ratio [OR], 2.9; 95% CI, 2.078-4.208; P<.0001), younger mean age at diagnosis (23.6±11.3 years in patients with granulomas vs 27.9±13.3 years in patients without; P=.0005), higher rates of stricturing or penetrating disease phenotype, higher rates of steroid and narcotic use, and higher healthcare utilization. Among patients that underwent surgery, the presence of granulomas was associated with need for repeat surgery during the 6-year observation period (OR, 2.5; 95% CI, 1.54-4.02; P=.0002). Infliximab use was associated with detection of granuloma in a significantly lower proportion of surgical specimens compared to patients who had not been treated with a biologic agent (OR=0.22; 95 CI, 0.05-0.97; P=.03).


Epithelioid granulomas develop in less than 13% of patients with CD, and are associated with a more aggressive disease phenotype. Patients who have undergone surgery for CD and have granulomas are at increased risk for repeat surgery within 6 years.
Both of our children diagnosed with Crohn's had granulomas on diagnosis. They are early in their journey. Our daughter was diagnosed 4 years ago and our son this year. Time will tell. Thank you for posting.

my little penguin

Staff member
Same here granulomas on biopsy at dx
Latest scopes as of last week look normal after 8 years
Biopsies should be back this week
thanks for sharing Lady Organic.
I can't help to think this is inline with the research linking MAP and E.Coli to Crohn's disease, held up against the knowledge that Crohn's is not an autoimmune disease, but rather an immunodeficiency (inability to handle certain immunological challenges).
Granulomas "form when the immune system attempts to wall off substances it perceives as foreign but is unable to eliminate. Such substances include infectious organisms including bacteria and fungi ...[]" . Source: wikipedia
Yet another reason for me to stay clear of dairy and beef.