Granulomatous Crohn's disease follows a more aggressive clinical course?

Abstract

AbstractObjectiveThis study aimed to define and compare the clinical course of granulomatous (GCD) vs non‐granulomatous Crohn's disease (NGCD).MethodologyAll consecutive patients who had undergone small or large bowel resection for Crohn's disease from 2000 to 2008 in a District General Hospital were collated retrospectively for histological evidence of GCD vs NGCD. Patients were assessed using the Montreal classification and data were collected for the number of recurrences requiring hospital admissions, re‐operations and septic complications over a follow‐up period of 10 or more years.ResultsFifty‐four patients were included in the study, 28 had GCD and 26 NGCD. The mean follow up for both groups was 13.5 years. No patients were excluded. Patients with GCD were younger but there were no other differences in age, sex, family history and smoking status. In patients with confirmed granulomata on resectional histology, there was an increased incidence of subsequent intra‐abdominal abscess formation after surgery (P < .05), an increased number of subsequent operations (P < .05) and shorter time to recurrences requiring hospital admissions (P < .05). The granulomatous cohort of patients had an apparent but not significant increased incidence of fistulating disease and stoma formation.ConclusionsThis study showed an increased risk of postoperative complications in patients with granulomatous Crohn's disease. Further studies are required to confirm that presence of granulomas in Crohn's disease is predictive of a poor prognosis and the need for more aggressive medical management.