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P137 Is there an abuse in the histological diagnosis of Crohn’s disease? (retrospective study)

A. Abou Rached1, J. Sanyour2, J. Karaki3, N. abi abdalllah4, S. Ghoussoub3

1Lebanese university- school of medecine, Gastroenterology, Beirut, Lebanon, 2Lebanese university- school of medecine, Gastroenterology, Hadath, Lebanon, 3Lebanese university- school of medecine, Internal medecine, Hadath, Lebanon, 4Lebanese uniiversity- school of medecine, internal medecine, Hadath, Lebanon

Background

Nine histological lesions are suggestive of the presence of Crohn’s disease: Ulcerations, erosions, granulomas, abscesses, chronic inflammation, lymphoid hyperplasia, fibro-inflammatory dystrophy, atrophy, and acute inflammation. The presence of a granuloma with at least one of the other histological lesions or the presence of at least three of these histological lesions without any granuloma will be in favor of Crohn’s disease diagnosis. The objective of our study is to review the pathology reports of patients in whom Crohn’s disease diagnosis was made and to see if they meet these histological diagnosis criteria.

Methods

It is a retrospective study whose aim is to review all histopathological reports of patients diagnosed with Crohn’s disease over a period of 10 years (2007–2017) in the largest pathology centre in Beirut. Several elements were analysed: the age, the sex, localisation of the endoscopic lesions (esophagus, stomach, duodenum, ileum and colon) as well as the number and the type of histological lesions present.

Results

During this period the number of patients diagnosed with Crohn’s disease was 3336. The mean age was 39.8, women accounted for 45.7%. The most common histological lesions in the colon and stomach were chronic inflammation (73.2% and 60.7%, respectively, acute inflammation in the ileum (79.8%), in the duodenum (80.6%) and in the esophagus in 88.2%, the presence of granuloma was noted in 22.9% of cases. The presence of granuloma with one or more other lesions was noted in 22.6%, whereas the presence of more than 3 histological criteria and more were found only in 29.4% of the biopsies.

Conclusion

This study demonstrates that only 52% of the biopsy specimens had the histological criteria necessary for the diagnosis of Crohn’s disease. A correlation with endoscopy findings and the clinics is needed to confirm the diagnosis of Crohn’s disease in 48% of patients.