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New insights into gastrointestinal and hepatic granulomatous disorders

Nature Reviews Gastroenterology & Hepatology volume 8, pages 455–466 (2011)Cite this article

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Abstract

Numerous diseases that involve the gastrointestinal tract reveal the presence of granulomas on histological analysis. Granulomatous diseases can be either primary or secondary to environmental factors. Granulomas are dynamic structures composed of organized collections of activated macrophages, including epithelioid and multinucleated giant cells, surrounded by lymphocytes. The formation of granulomas is usually in response to antigenic stimulation and is orchestrated through cytokines, immune cells and host genetics. In this Review, the pathogenesis and etiologies of granulomas of the gastrointestinal tract and liver are discussed, as are the available diagnostic tools to help differentiate their various underlying etiologies. In addition, the role of granulomas in harboring latent tuberculosis is reviewed. The effects of tumor necrosis factor antagonists and interferon-α on the development of granulomas are also discussed.

Key Points

  • Granulomas may be detected incidentally or as the result of extensive investigations undertaken to identify the etiology of a systemic illness

  • There have been major developments in identifying key genetic predispositions to granulomatous disorders, such as Crohn's disease and Blau syndrome

  • Granulomas are dynamic structures that require the persistent stimulation of activated macrophages and cytokines from T cells

  • Sarcoidosis induced by anti-tumor necrosis factor or interferon-α has increasingly been reported in the literature

  • The management of patients with a granulomatous disease should take into account their symptoms, the natural history and severity of underlying disease, and the benefits and risks associated with proposed therapy

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Figure 1: A granuloma seen on an endoscopic biopsy sample from a patient known to have Crohn's disease.
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Figure 3: Liver tissue from a patient with schistosomasis.
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Acknowledgements

We would like to thank Dr Hussa F. AlHussaini for providing us with the granuloma pathology images.

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Authors and Affiliations

  1. Department of Medicine, Gastroenterology Division, King Khalid University Hospital, King Saud University, PO Box 231494, Riyadh, 11321, Saudi Arabia

    Majid A. Almadi & Abdulrahman M. Aljebreen

  2. Department of Hepatobiliary Sciences and Liver Transplantation, King Abdulaziz Medical City, PO Box 22490, Riyadh, 11426, Saudi Arabia

    Faisal M. Sanai

  3. Department of Pathology, McGill University Health Center, McGill University, 687 Pine Ave West, Montreal, H3A 1A1, QC, Canada

    Victoria Marcus

  4. Department of Medicine, Gastroenterology and Hepatology Division, Riyadh Military Hospital, PO Box 7897, Riyadh, 11159, Saudi Arabia

    Ebtissam S. AlMeghaiseeb

  5. Department of Medicine, Faculty of Medicine, University of Calgary, 1403–29 Street North West, Calgary, T2N 2T9, AB, Canada

    Subrata Ghosh

Authors
  1. Majid A. Almadi
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  2. Abdulrahman M. Aljebreen
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  3. Faisal M. Sanai
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  4. Victoria Marcus
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  5. Ebtissam S. AlMeghaiseeb
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  6. Subrata Ghosh
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Contributions

M. A. Almadi and F. Sanai contributed to all aspects of this Review including writing. A. M. Aljebreen, E. S. AlMeghaiseeb, and V. Marcus provided a substantial contribution to the discussion of content and the review/editing of the manuscript before submission. S. Ghosh researched data for the article and provided a substantial contribution to the discussion of content and the review/editing of the manuscript before submission.

Corresponding author

Correspondence to Majid A. Almadi.

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The authors declare no competing financial interests.

Supplementary information

Supplementary Table 1

Selected features of diseases that are associated with gastrointestinal and hepatic granulomatous disorders (DOC 89 kb)

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Almadi, M., Aljebreen, A., Sanai, F. et al. New insights into gastrointestinal and hepatic granulomatous disorders. Nat Rev Gastroenterol Hepatol 8, 455–466 (2011). https://doi.org/10.1038/nrgastro.2011.115

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