The Granuloma in Crohn's Disease

Schmitz-Moormann, P; Pittner, P.M.; Malchow, H.; Brandes, J W

doi:10.1016/s0344-0338(84)80007-2

Cited by 37 publications

(20 citation statements)

References 10 publications

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“…While this can be looked at as a limiting factor, it is one commonly encountered in the clinical practice where typical epithelioid granulomas are usually found in approximately only 30±40 % of patients with Crohn's disease [20]. a b Fig.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of enteroclysis in Crohn's disease of the small bowel: a retrospective study

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Noce

et al. 2000

European Radiology

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The aim of this study was to evaluate the accuracy of enteroclysis in the diagnosis of Crohn's disease of the small bowel in a group of consecutive patients. From January 1992 to December 1995, 165 patients with suspected Crohn's disease of the small bowel presented to our institution for enteroclysis. In 14 patients up to three enteroclysis exams were performed. Most patients (78%) underwent colonoscopy and retrograde ileoscopy. In the remaining patients clinical follow-up was used as gold standard. In 79 patients no radiographic abnormalities were found. Sixty-one patients (40 men and 21 women; mean age 34.2 years) had a radiological diagnosis of Crohn's disease. This involved the terminal ileum in 39 patients (64%) either alone (n = 25) or in association with the pelvic ileum (n = 14). In 12 of these patients retrograde ileoscopy was not feasible. Twenty-one patients underwent surgery. In 4 patients pathology revealed diseases other than Crohn's. These patients had all ileocecal diseases (tuberculosis = 2; non-Hodgkin's lymphoma = 1; adenocarcinoma = 1). One false-negative result was observed. Overall, enteroclysis showed a sensitivity of 98.2% and a positive predictive value of 93.4%. Enteroclysis is a sensitive technique in evaluating both the extent and the severity of small bowel involvement in Crohn's disease, although the overlap of radiographic findings may hamper its accuracy when the disease is confined to the ileocecal area.

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Section: Discussionmentioning

confidence: 99%

Accuracy of enteroclysis in Crohn's disease of the small bowel: a retrospective study

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Noce

et al. 2000

European Radiology

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“…(133,227,246) and in tuberculosis and other mycobacterial infections (125,203 All major texts on gastroenterology and mycobacteriology make reference to the possible mycobacterial etiology of Crohn's disease. This is surprising, particularly in older texts, since the data which suggested such an association were sparse when these texts were written ( (198,242), or even fewer (132). Based on epidemiologic data, it has been estimated that at least 20% of Crohn's disease diagnoses are misclassifications (36) 108 CHIODINI unique among the mycobacteria because the gastrointestinal tract is the only environment in which it can replicate in vivo.…”

Section: Epidemiologymentioning

confidence: 99%

Crohn's disease and the mycobacterioses: a review and comparison of two disease entities

1989

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Crohn's disease is a chronic granulomatous ileocolitis, of unknown etiology, which generally affects the patient during the prime of life. Medical treatment is supportive at best, and patients afflicted with this disorder generally live with chronic pain, in and out of hospitals, throughout their lives. The disease bears the name of the investigator who convincingly distinguished this disease from intestinal tuberculosis in 1932. This distinction was not universally accepted, and the notion of a mycobacterial etiology has never been fully dismissed. Nevertheless, it was 46 years after the distinction of Crohn's disease and intestinal tuberculosis before research attempting to reassociate mycobacteria and Crohn's disease was published. Recently, there has been a surge of interest in the possible association of mycobacteria and Crohn's disease due largely to the isolation of genetically identical pathogenic Mycobacterium paratuberculosis from several patients with Crohn's disease in the United States, the Netherlands, Australia, and France. These pathogenic organisms have been isolated from only a few patients, and direct evidence for their involvement in the disease process is not clear; however, M. paratuberculosis is an obligate intracellular organism and strict pathogen, which strongly suggests some etiologic role. Immunologic evidence of a mycobacterial etiology, as assessed by humoral immune determinations, has been conflicting, but evaluation of the more relevant cellular immunity has not been performed. Data from histochemical searches for mycobacteria in Crohn's disease tissues have been equally conflicting, with acid-fast bacilli detected in 0 to 35% of patients. Animal model studies have demonstrated the pathogenic potential of isolates as well as elucidated the complexity of mycobacterial-intestinal interactions. Treatment of Crohn's disease patients with antimycobacterial agent has not been fully assessed, although case reports suggest efficacy. The similarities in the pathology, epidemiology, and chemotherapy of Crohn's disease and the mycobacterioses are discussed. The issue is fraught with controversy, and the data generated on the association of mycobacteria and Crohn's disease are in their infantile stages so that a general conclusion on the legitimacy of this association cannot be made. While no firm evidence clearly implicates mycobacteria as an etiologic agent of Crohn's disease, the notion is supported by suggestive and circumstantial evidence and a remarkable similarity of Crohn's disease to known mycobacterial diseases.

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“…Unfortunately, there are few reports in the literature regarding the frequency of granulomas in Crohn’s colitis at baseline (initial) colonoscopies. Molnar et al 10 found granulomas in 10/18 adults (55.6%), and Schmitz-Moormann et al 11 postulated that “repetitions of the endoscopy raised the frequency of finding a granuloma from 23% for one endoscopy to 48% for 4 endoscopies”. As the series of Schmitz-Moormann et al also included rectoscopic biopsies, it is unclear how many “endoscopies” were colonoscopies and how many only rectoscopies.…”

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confidence: 99%

Frequency of epithelioid granulomas in colonoscopic biopsy specimens from paediatric and adult patients with Crohn’s colitis

et al. 2007

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Aims: To test the assumption that epithelioid granulomas found in colonoscopic biopsy specimens in patients with Crohn's colitis are markers of a different clinical behaviour. Methods: Sections from colonoscopic biopsy specimens from 352 consecutive patients (119 children and 233 adults) were investigated. Results: A total of 1117 colonoscopies were performed: 293 in children (mean 2.46 per patient) and 824 in adults (mean 3.53 per patient) (p,0.05). Granulomas at initial colonoscopy were recorded in 67.2% (43/ 64) of children and 65.9% (27/41) of adults (p.0.6), and at subsequent colonoscopies in 53.8% (64/119) of children and 17.6% (41/233) of adults (p,0.05). Surgical intervention was required in 6.3% (4/64) of the children having previous granuloma, but also in 14.5% (8/55) of those without previous granuloma, the rate for operated adults being 26.8% (11/41) and 24.5% (47/192), respectively (p.0.6). Conclusions: Granulomas in entry and/or in subsequent colonoscopic biopsy specimens in patients with Crohn's colitis did not predict the need for subsequent surgical intervention. The fact that the frequency of granulomas was significantly higher in children than in adults with Crohn's colitis (despite a higher mean number of colonoscopic biopsies in adults), and that granulomas were present in colonoscopic biopsy specimens but not in the subsequent surgical specimens from 50% of the paediatric and 36% of the adult patients strengthen the conviction that granulomas in Crohn's colitis might evolve or regress at different time intervals during the course of the disease. This behaviour would reflect a particular immunological reaction, an epiphenomenon from immature tissues-as in children-when challenged by the so far elusive aetiological agent responsible for Crohn's disease.

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The Granuloma in Crohn's Disease

Cited by 37 publications

References 10 publications

Accuracy of enteroclysis in Crohn's disease of the small bowel: a retrospective study

Accuracy of enteroclysis in Crohn's disease of the small bowel: a retrospective study

Crohn's disease and the mycobacterioses: a review and comparison of two disease entities

Frequency of epithelioid granulomas in colonoscopic biopsy specimens from paediatric and adult patients with Crohn’s colitis

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