Histopathological parameters as predictors for the course of Crohn's disease.
BACKGROUND
Recent classification systems discriminate penetrating Crohn's disease (CD) from stricturing and non-stricturing/non-penetrating CD. As yet, no easily detectable marker is known that can predict the course of CD. Individual, clinical course-specific new treatment schemes would be highly desirable for different potentially divergent pathophysiological pathways (e.g., fistula vs stenosis).


METHODS
Intestinal tissue biopsies from 63 CD patients with a disease follow-up of up to 7 years were studied retrospectively. In biopsy specimens, 34 histopathological features present prior to the onset of (a) strictures or (b) fistulas were evaluated and compared with biopsies from patients with non-stricturing/non-penetrating disease.


RESULTS
Five histomorphological parameters demonstrated significant associations to different disease courses when applying univariate analysis. In a multivariate logistic regression model (1) severe lymphocytic infiltration of the lamina propria, (2) presence of crypt atrophy, and (3) absence of lymphocytic infiltration of the epithelium are the best variables to predict an uncomplicated disease course (Nagelkerke R2=0.329; P=0.001). The combination of these parameters has a sensitivity of 67% and a specificity of 83% to predict non-stricturing/non-penetrating disease (positive predictive value=0.75).


CONCLUSIONS
Histopathological parameters may help to predict complications of CD prior to their onset. The results of this study have to be confirmed prospectively.
Bataille
Frauke
F
Department of Pathology, University of Regensburg, 93042 Regensburg, Germany. frauke.bataille@klinik.uni-regensburg.de
Klebl
Frank
F
Rümmele
Petra
P
Straub
Rainer H
RH
Wild
Peter
P
Schölmerich
Jürgen
J
Hofstädter
Ferdinand
F
D000328:Adult; D003424:Crohn Disease / Q000150:complications / Q000473:pathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies