Association of intestinal granulomas with smoking, phenotype, and serology in Chinese patients with Crohn's disease.
BACKGROUND
Crohn's disease (CD) is a heterogenous disease characterized by variable manifestations and outcomes, and increasing in incidence in China. Phenotypic classification has been proposed to assist in subtyping of disease. Non-caseating intestinal granulomas are a hallmark of CD, but whether intestinal granulomas help predict Chinese CD phenotypes or determine severity, is not known.


OBJECTIVE
To determine the association between intestinal granulomas with CD phenotype, severity, risk factors, and serological markers.


METHODS
This was a single-centre study of consecutive definite Chinese CD cases. Granulomas were diagnosed by an experienced GI pathologist. Correlation with the Vienna Classification and other parameters was performed.


RESULTS
Eighty Chinese CD patients were recruited, 40 (50%) of whom had intestinal granulomas. Intestinal granulomas were independently associated with the stricturing behavior (OR: 4.71; 95% CI: 1.41-15.72), colonic location of disease (OR: 26.96; 95% CI: 2.68-271.14), but not with age of CD diagnosis. Current or previous smoking protected against the development of granulomas (OR: 0.16; 95% CI: 0.04-0.59). Granulomas were not associated with peri-anal involvement, extra-intestinal manifestations, anti-neutrophil cytoplasmic antibody or anti-Saccharomyces cerevisiae antibody serology, or severity of CD gauged by the requirement of major intestinal surgery or immunomodulating therapy.


CONCLUSIONS
Intestinal granulomas in the setting of CD may be helpful in determining phenotypic subtypes of CD, but is unhelpful in predicting disease severity. Smoking impairs the formation of granulomas in CD.
Leong
Rupert W L
RW
Faculty of Medicine, The University of New South Wales, Department of Gastroenterology, Bankstown-Lidcombe Hospital, Sydney, Australia.
Lawrance
Ian C
IC
Chow
Dorothy K L
DK
To
Ka-Fai
KF
Lau
James Y
JY
Wu
Justin
J
Leung
Wai K
WK
Chan
Francis K L
FK
Sung
Joseph J Y
JJ
D000328:Adult; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis; D000908:Antibodies, Fungal / Q000032:analysis; D044466:Asian People; D002681:China; D003424:Crohn Disease / Q000150:complications* / Q000276:immunology; D005260:Female; D006099:Granuloma / Q000150:complications*; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications*; D008297:Male; D010641:Phenotype; D012307:Risk Factors; D012441:Saccharomyces cerevisiae / Q000276:immunology; D012907:Smoking
D019268:Antibodies, Antineutrophil Cytoplasmic; D000908:Antibodies, Fungal