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P266 Clinical significance of granulomas in Crohn’s disease: a meta-analysis

S. W. Hong1, H. Yoon*2, C. M. Shin2, Y. S. Park2, N. Kim1,2, D. H. Lee1,2, J. S. Kim1

1Seoul National University College of Medicine, Seoul, South Korea, 2Seoul National University Bundang Hospital, Seongnam-si, South Korea

Background

Epithelioid granuloma is one of the hallmarks in histological diagnosis of Crohn’s disease (CD). However, the clinical significance of granulomas in CD is still unclear. We performed a meta-analysis to compare the clinical characteristics and prognosis of patients with CD according to the presence of granulomas.

Methods

A literature search in PubMed, EMBASE, and Cochrane database was performed published until December 2017. We included studies that met the following inclusion criteria; (1) patient: patients with CD; (2) exposure: granulomas on the endoscopic or surgical pathology; (3) comparator: no granulomas on the pathologic finding; (4) outcomes: the clinical features (location of disease, presence of perianal disease, extraintestinal manifestations, and disease activity at presentation) and prognosis (CD-associated surgery, hospitalisation, and use of biologics).

Results

We identified 20 studies meeting inclusion criteria. In terms of the clinical features, the presence of granulomas in patients with CD was associated with a higher proportion of disease involving both small and large intestine (odds ratio (OR): 1.49, 95% confidence interval (CI): 1.21–1.83, p < 0.001), a higher prevalence of perianal disease (OR: 2.47, 95% CI: 1.49–4.10, p < 0.001), and a higher severity index at presentation (standardised mean difference: 0.21, 95% CI: 0.03–0.40, p = 0.02). The pooled prevalence of extraintestinal manifestations was not significantly different according to the presence of granuloma (OR: 1.21, 95% CI: 0.79–1.84, p = 0.38). Regarding the factors related to prognosis, CD-associated hospitalisation (risk ratio (RR): 1.84, 95% CI: 1.09–3.11, p = 0.02) and use of biologics (RR: 1.30, 95% CI: 1.01–1.66, p = 0.04) were more common in CD patients with granuloma when compared with patients without granulomas. CD-associated surgery showed an increasing trend in CD patients with granuloma, but was not significant (RR: 1.41, 95% CI: 0.97–2.06, p = 0.07).

Conclusion

This meta-analysis demonstrated that the clinical features and prognosis in patients with CD were significantly different according to the presence of granulomas; it may indicate a more aggressive phenotype of CD.