Research

Granulomas at initial diagnosis of Crohn’s disease signal a poor outcome

Gillian Ann Watermeyer, Sandie R Thomson

Abstract


Background. Over time, most patients with Crohn’s disease (CD) develop strictures or fistulas, resulting in hospitalisations and surgery. Timely therapy with immunomodulators and biologicals may alter this natural history, but carries a significant risk of side-effects.

Objective. To identify factors to predict poor-outcome severe CD at diagnosis, and thus patients who would benefit most from early, aggressive medical therapies.

Methods. CD patients (n=101) with uncomplicated non-stricturing, non-penetrating disease at diagnosis, and with follow-up >5 years, were retrospectively analysed using a predefined definition of severe CD (SCD) over the disease course. Clinical, demographic, laboratory and histological factors at diagnosis associated with SCD and poor outcome were evaluated by univariate and multivariate analysis.

Results. Overall 33.7% of the cohort developed SCD, and on multivariate Cox proportional hazard analysis the presence of granulomas on endoscopic biopsy at diagnosis was independently associated with development of SCD (hazard ratio (HR) 2.3; 95% confidence interval (CI) 1.15 - 4.64; p=0.02). Simple perianal disease was also associated with this outcome (HR 2.49; 95% CI 1.14 - 5.41; p=0.02). The presence of these variables had a specificity of 99% and a positive predictive value of 88%.

Conclusion. At diagnosis, factors predictive of SCD in our referral centre were the presence of endoscopic biopsy granulomas and perianal disease. Patients with these risk factors should be considered for early, aggressive medical therapy, as benefit will probably outweigh risk. To our knowledge, this is the first study to show that endoscopic biopsy granulomas in patients with uncomplicated (non-stricturing, nonpenetrating) CD predict the subsequent development of SCD.


Authors' affiliations

Gillian Ann Watermeyer, Division of Gastroenterology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa

Sandie R Thomson, Division of Gastroenterology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa

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Keywords

Inflammatory bowel disease; Crohn's disease; Disease course; Complications; Outcomes; Natural history; Granulomas; Biopsy

Cite this article

South African Medical Journal 2015;105(6):480-483. DOI:10.7196/SAMJ.9093

Article History

Date submitted: 2015-09-18
Date published: 2015-09-18

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