Histology of the Stomach and Duodenum in Crohn's Disease

Abstract

Crohn's disease (CD) not uncommonly affects the stomach and duodenum, but its histologic appearance is not well described beyond the identification of granulomas. We retrospectively identified 209 upper gastrointestinal biopsy samples from 80 sets of biopsies from 49 patients with CD. Age- and sex-matched control biopsies were selected from recent cases of Helicobacter pylori gastritis (73 biopsy samples from 34 patients), from patients with a known history of nonsteroidal antiinflammatory drug use (18 biopsy samples from 12 patients), and from three patients with ulcerative colitis. Architectural and inflammatory changes were evaluated and compared. Over three fourths of the patients with CD had abnormal biopsy results. Fifty-six percent of patients with CD had acute inflammation, but only 10% of the patients were infected with H pylori. Focal acute inflammation was a characteristic of H pylori-negative CD (stomach, 31%; duodenum, 40%), which was much less common in the non-CD group (stomach, 2%; duodenum, 8%). Surface intraepithelial neutrophils of the duodenum were more common in H pylori-negative patients with CD (25%) than in those who did not have CD (4%), and deep acute inflammation of the duodenum was more likely in H pylori-negative patients with CD (19% vs. 0%). Granulomas were found in only 9% of the CD group. Focal acute inflammation of the gastroduodenum, especially in a background of noninflamed mucosa, is strong evidence for CD in the appropriate clinical context, but the stomach and duodenum must be properly sampled and carefully examined for any evidence of H pylori.

Gastritis and Carditis

“…Microscopic inflammation is, however, considerably more common and may be detected in between 8 and 75% of patients (101,102). Some of the gastritis in these individuals can be attributed to H. pylori infection (10 -33%), but in approximately 50% of individuals, the inflammation is considered to be a direct involvement by Crohn's disease.…”

“…Some of the gastritis in these individuals can be attributed to H. pylori infection (10 -33%), but in approximately 50% of individuals, the inflammation is considered to be a direct involvement by Crohn's disease. In approximately 10% of cases, mucosal granulomas may be detected (102), although the yield will be greatest when large numbers of biopsies are taken. In the nongranuloma cases, focal acute inflammation with a background of normal mucosa (focally enhanced gastritis) is the lesion most commonly encountered (101-102; Table 5).…”

“…Focally enhanced gastritis is more frequent in the antral mucosa (48%) than in the corpus mucosa (24%) of patients with upper intestinal Crohn's disease (101). Small numbers of patients with Crohn's disease may also have lymphocytic gastritis (102). In the duodenum, surface epithelial infiltration by neutrophils and deep acute inflammation may be encountered (102).…”

Pathology of non-Helicobacter pylori gastritis: extending the histopathologic horizons

“…Although clinically apparent gastric involvement by Crohn's disease is seen in only about 2-7% of patients, recent series have reported the presence of endoscopic and microscopic evidence in 34-83% of patients [77]. The endoscopic appearance is variable, ranging from normal (common), to nodular or thickened folds to aphthous or linear ulcerations, to mural rigidity (uncommon) [78].…”

“…Shallow ulcers can be seen as well, but sharp, deep fissure-like erosions have been associated with the bamboo joint-like appearance [79]. Loose mucosal granulomas with or without giant cells may also be detected with a wide incidence (between 0 and 83%) depending on the sampling and the age of the patients, and duration of disease [77] (Fig. 12a, b).…”