title: Significance of the epithelioid granuloma in biopsies of Crohn's colitis.
abstract: BACKGROUND
  The relevance of granulomas in biopsy specimens from patients with Crohn's disease is largely unknown. Most previous studies have been performed on small samples and have produced conflicting results. This study was designed to compare the demographic, clinical, and histopathologic characteristics of a large cohort of documented patients with Crohn's disease with and without epithelioid granulomas.
  
  
  METHODS
  Data of all patients with Crohn's disease were extracted from a computerized database of 1.3 million subjects who underwent colonoscopy and had their biopsy specimens diagnosed by a single group of gastrointestinal pathologists. The influence of age, gender, patient symptoms, and histopathologic finding on the presence of granuloma was analyzed.
  
  
  RESULTS
  There were 10,456 patients with Crohn's disease: 952 (9%) patients harbored granulomas (cases) and 9504 (91%) patients (controls) had none. Cases were significantly younger than controls: 42.4 ± 17.9 versus 48.0 ± 16.4 years (P < 0.0001). Cases presented with more symptoms than controls (odds ratio, 95% confidence interval): diarrhea (2.29, 2.28-2.31), anemia (2.06, 2.02-2.10), vomiting (2.13, 2.07-2.19), abdominal pain (1.75, 1.72-1.78), hematochezia (1.97, 1.94-2.00), and weight loss (3.94, 3.93-3.94). In a multivariate logistic regression analysis, younger age, presence of chronic active colitis, and symptoms of weight loss remained independent statistically significant predictors for the presence of granulomas.
  
  
  CONCLUSIONS
  In colonic biopsies from patients with Crohn's disease, granulomas constitute a rare finding. Presence of granulomas is associated with younger patient age, more severe histopathologic expression of the underlying disease, and more clinical symptoms.
authors.affiliation: *Miraca Life Sciences Research Institute, Irving, Texas; and †Department of Medicine, Oregon Health & Sciences University, Portland, Oregon.
authors.forename: Kevin
authors.initials: K
authors.lastname: Turner
authors.forename: Robert M
authors.initials: RM
authors.lastname: Genta
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lujan
authors.forename: Cristian
authors.initials: C
authors.lastname: Robiou
authors.forename: Amnon
authors.initials: A
authors.lastname: Sonnenberg
mesh_terms: D000328:Adult; D001706:Biopsy; D016022:Case-Control Studies; D003113:Colonoscopy; D003424:Crohn Disease / Q000150:complications* / Q000473:pathology / Q000601:surgery; D004724:Endoscopy; D015622:Epithelioid Cells / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006099:Granuloma / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis