title: Clinical significance of granuloma in Crohn's disease.
abstract: OBJECTIVE
  Granuloma is considered the hallmark of microscopic diagnosis in Crohn's disease (CD), but granulomas can be detected in only 21-60% of CD patients. The aim of this study was to evaluate the frequency of granulomas by multiple endoscopic biopsies in patients with CD and to examine whether group of patients with or without granuloma exhibit a different clinical course.
  
  
  METHODS
  Fifty-six patients with newly diagnosed CD were included in the study. Jejunoscopy, enteroclysis and ileo-colonoscopy were performed in all patients. At least two biopsy specimens from each examined gastrointestinal segment were examined microscopically searching granuloma. The clinical course was followed in all patients, and extraintestinal manifestations as well as details of any immunosuppressive therapy and surgical intervention were noted.
  
  
  RESULTS
  Granuloma was found in 44.6% of the cases (25 patients). Patients with granuloma had higher activity parameters at the time of the biopsies. Extraintestinal manifestations were observed and surgical interventions were performed more often in the granuloma group. The need of immunosuppressive therapy was significantly more frequent in the patients with granuloma. Granuloma formation is more often seen in younger patients, and mainly in the severe, active penetrating disease.
  
  
  CONCLUSIONS
  The significantly higher frequency of surgical interventions and immunosuppressive therapy suggests that granuloma formation is associated with a more severe disease course during the first years of CD.
authors.affiliation: First Department of Medicine, Faculty of Medicine, University of Szeged, H-6720 Szeged, Korányi fasor 8., Hungary. mot@in1st.szote.u-szeged.hu
authors.forename: Tamas
authors.initials: T
authors.lastname: Molnár
authors.forename: László
authors.initials: L
authors.lastname: Tiszlavicz
authors.forename: Csaba
authors.initials: C
authors.lastname: Gyulai
authors.forename: Ferenc
authors.initials: F
authors.lastname: Nagy
authors.forename: János
authors.initials: J
authors.lastname: Lonovics
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003424:Crohn Disease / Q000150:complications* / Q000473:pathology; D005260:Female; D006099:Granuloma / Q000150:complications* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis