Colonic Crohn's Disease: A Clinical/Pathologic and Outcome Study of 120 Patients
G Soucy, JF Schmidt, JA Greenberg, S Cerda, K Dendrinos, F Farraye, AB Farris, GY Lauwers, HH Wang, RD Odze. Brigham and Women's Hospital, Boston; Boston University Medical Center, Boston; Massachusetts General Hospital, Boston; Beth Israel Deaconess Medical Center, Boston
Background: We have noted, anecdotally, that the clinical and pathologic manifestations of Crohn's disease (CD) of the colon are different in patients either with or without ileal involvement, but this type of analysis has never been performed. Thus, the aim of this study was to evaluate the clinical, pathologic and outcome features of the colon in patients with isolated colonic CD (ISCD) versus those with ileocolonic CD (ICCD), at initial presentation.
Design: Colonic resection specimens from 79 patients with ISCD and 41 patients evaluated during the same time period with ICCD, at initial presentation, were recruited from the files of 3 major university hospitals. All patients were evaluated for a wide variety of clinical and pathologic features (the latter also separated into major and minor CD features) and also for outcome (favorable or unfavorable) after surgery, in a blinded fashion without knowledge of the patient group. Major CD pathologic features included granulomas, transmural lymphoid aggregates, fissuring ulceration (FU), sinus tract formation, fistulas (fist), anal involvement, and segmental disease.
Results: Clinically, patients with ISCD were significantly older (37 vs. 26 years, p=0.006), but did not differ with regard to gender or race. Grossly, the colon from ISCD patients revealed a significantly lower percentage of stricture/stenosis (p=0.003), adhesions (p<0.001), fist formation (p=0.01), a higher proportion of cases with worse disease in the distal vs. proximal colon (p<0.001), a higher rate of left sided colitis (p<0.001), overall lower severity of disease (p=0.001), a lower prevalence rate of FU (p<0.001), and a nearly significant increased rate of anal involvement (p=0.09) compared to the colon of patients with ICCD. In addition, ISCD patients showed significant fewer major CD features compared to ICCD. No differences in colonic dysplasia were noted. Upon follow-up, no significant differences were noted between the two groups with regard to an unfavorable outcome.
Conclusions: The colon in patients with ISCD at initial presentation show less frequent classic CD features and, thus, resemble ulcerative colitis more frequently than the colon of patients with ICCD. However, outcome after surgery is similar and, thus, ISCD and ICCD should be managed similarly.
Wednesday, March 11, 2009 9:30 AM
Poster Session V # 63, Wednesday Morning