title: Histopathological parameters as predictors for the course of Crohn's disease.
abstract: 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.
authors.affiliation: Department of Pathology, University of Regensburg, 93042 Regensburg, Germany. frauke.bataille@klinik.uni-regensburg.de
authors.forename: Frauke
authors.initials: F
authors.lastname: Bataille
authors.forename: Frank
authors.initials: F
authors.lastname: Klebl
authors.forename: Petra
authors.initials: P
authors.lastname: Rümmele
authors.forename: Rainer H
authors.initials: RH
authors.lastname: Straub
authors.forename: Peter
authors.initials: P
authors.lastname: Wild
authors.forename: Jürgen
authors.initials: J
authors.lastname: Schölmerich
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Hofstädter
mesh_terms: D000328:Adult; D003424:Crohn Disease / Q000150:complications / Q000473:pathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies