The Phenotype and Clinical Course of Pediatric Crohn’s Disease With Granulomas: A Retrospective Cohort Study

Objectives: The significance of granulomas has still not been clarified in pediatric onset Crohn’s disease (CD). The aim of this study was to investigate the phenotype and clinical course in CD patients with granuloma in a comprehensive cohort. Materials and Methods: Histopathological findings of 317 endoscopic procedures of 81 pediatric CD patients were retrospectively analyzed. The phenotype of the patients and long-term follow-up data were compared in patients with and without granuloma. Results: At diagnosis, granuloma was detected in at least 1 biopsy in 39.5% of the patients. Patients with granuloma had significantly higher rate of ileocolonic disease, upper gastrointestinal involvement (68.7% vs 36.7%) and moderate-severe activity at diagnosis compared to patients without granuloma. In multivariate analysis, the presence of granulomas was associated with an increased risk of exacerbation (HR = 1.52; 95% CI: 0.83-2.75; P > .05). Patients with granuloma experienced earlier exacerbation and developed fistulizing perianal disease more frequently ( P = .02) and significantly earlier ( P = .002) than patients without granulomas. Conclusions: Our results suggest that granulomas were associated with a distinct phenotype characterized by extensive involvement. Considering the clinical course, it is thought that granulomas may be a predictor of aggressive disease course and potential modifier of treatment strategy.