2899 Description of Outcomes in Inflammatory Bowel Disease Patients With Granuloma on Histology: A Single-Center Experience

Abstract

INTRODUCTION: It has been suggested that the presence of granulomas on surgical pathology of patients with Crohn’s disease (CD) is associated with a more aggressive disease phenotype. We sought to investigate the outcomes of patients who had granulomas present on their surgical specimens. METHODS: This was a retrospective chart review that identified all inflammatory bowel disease patients who had the word ‘granuloma’ listed on their pathology report, whether from an endoscopic procedure (EGD or colonoscopy) or surgical resection specimen. We search reports from 1997 to 2019. All patients who had an intestinal granuloma were identified. Demographic, clinical, and histologic information was obtained from the medical records of these patients. RESULTS: A total of 41 CD patients were found to have a granuloma on their surgical specimen; 8 were found on a surgical resection specimen while 33 were found on endoscopic biopsies. Of the 41 patients, 53.7% were males, 41.7% were smokers, and the average age at diagnosis of these patients was 32 ± 15 years. The most common site for granuloma detection was the ileum accounting for 23 cases (56%). A total of 13 patients had granulomas present in more than one site/location (31.7%). The median C-reactive protein within 2 weeks of colonoscopy for patients with granuloma was 16.5mg/L; IQR 2.9-58 (normal < 2.5mg/L), median erythrocyte sedimentation rate was 25mm/hr; IQR 15-45 (normal 17.5mm/hr), and median hemoglobin of these patients was 12g/dL; IQR 10.3-13.6 (normal 12.5g/dL). Of the 41 CD patients with granulomas, 42.5% were on a biologic agent, 41% on an immunomodulatory, and 20% had received a steroid at any time for their disease. A total of 9 patients (24.3%) had stricturing disease, 15.2% had a history of an intra-abdominal abscess, and 13.9% had a history of peri-anal disease. A total of 32.5% of granuloma CD patients had an intestinal resection and 34% had a CD related hospitalization. CONCLUSION: As part of this study, we are hoping to match (age and gender) our CD patients with granulomas to CD patients who were not found to have granulomas on their surgical specimens and to compare the outcomes amongst these groups. Based on our descriptive data of the granuloma patients, we suspect that these patients will a more aggressive disease course.