Original Contribution
The American Journal of Gastroenterology (2006) 101, 1024–1029; doi:10.1111/j.1572-0241.2006.00503.x
Association of Intestinal Granulomas with Smoking, Phenotype, and Serology in Chinese Patients with Crohn's Disease
Rupert WL Leong MBBS, MD, FRACP1, Ian C Lawrance MBBS, PhD, FRACP2, Dorothy KL Chow MBChB, MRCP3, Ka-Fai To MBChB, FRCPA4, James Y Lau MBBS, MD5, Justin Wu MBChB, MD3, Wai K Leung MBChB3, Francis KL Chan MBChB, MD3 and Joseph JY Sung MBBS, MD, PhD3
- 1Faculty of Medicine, The University of New South Wales, Department of Gastroenterology, Bankstown-Lidcombe Hospital, Sydney, Australia
- 2School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Perth, Australia
- 3Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
- 4Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
- 5Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
Correspondence: Dr Rupert WL Leong, MBBS, FRACP, MD, Head of Department of Gastroenterology and Hepatology, Department of Gastroenterology, Level 3 Bankstown-Lidcombe Hospital, Sydney, Australia.
Received 7 September 2005; Accepted 7 November 2005.
Abstract
INTRODUCTION:
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.
AIMS:
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.
