Figure 2 - available from: Virchows Archiv
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Crohn’s disease inflammatory patterns in the duodenum and the large bowel. The duodenal mucosa can display villous blunting, intra-epithelial lymphocytosis and active chronic inflammation in the lamina propria mimicking coeliac disease (a) or active erosive chronic duodenitis (b). The large bowel mucosa shows elongated crypts with infiltration of the lamina propria by lymphocytes and plasma cells and mild intraepithelial lymphocytosis (lymphocytic colitis-like pattern) (c). Granulomas in the deep mucosa and the superficial submucosa can be present (d)
Source publication
Crohn’s disease is a chronic inflammatory disorder that can affect any part of the gastrointestinal tract. Our objective was to review the histological findings in index biopsies from the terminal ileum and other gastro-intestinal tract sites of Crohn’s disease patients prior any treatment and to compare them with the findings from patients with no...
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Background & aims:
Crohn's disease (CD) is a debilitating inflammatory disorder that affects more than 1.6 million people in North America alone. Members of the tumor necrosis factor superfamily are key regulators of intestinal inflammation; specifically, tumor necrosis factor-like weak inducer of apoptosis (TWEAK) and its receptor, fibroblast gro...
Tumor necrosis factor-like cytokine 1A (TL1A, TNFSF15) is implicated in inflammatory bowel disease (IBD), modulating the location and severity of intestinal inflammation and fibrosis. TL1A expression is increased in inflamed gut mucosa and associated with fibrostenosing Crohn’s disease. Tl1a-overexpression in mice lead to spontaneous ileitis, and e...
Citations
... Besides the main ileocolonic localization of CD, other affected areas include the anus, appendix, non-ileal small intestine, stomach, oesophagus and oropharynx mucosa [68][69][70][71][72]. In the non-ileal small intestine, including the duodenum, the most severe CDinduced damage occurs proximal to the ligament of Treitz and includes erosion, increased numbers of lamina propria plasma cells and neutrophils, crypt abscesses and pyloric gland metaplasia, often in the absence of granulomas; intraepithelial neutrophils can be observed. ...
... Gastric CD more frequently involves the distal portion of the stomach, including the antrum, and is characterized by the deep infiltration of inflammatory cells into the pits and glands [68][69][70][71][72]. Granulomas are almost always associated with focal active gastritis. ...
... Gastric CD more frequently involves the distal portion of the stomach, including the antrum, and is characterized by the deep infiltration of inflammatory cells into the pits and glands [68][69][70][71][72]. Granulomas are almost always associated with focal active gastritis. Oropharyngeal histological manifestations include chronic inflammation, granulation tissue and well-formed, nonnecrotizing granulomas [69]. ...
... Crohn's disease Although considered to be a hallmark of this disease, the reported frequency of granulomas in Crohn's disease varies from only 15 to 60%, with an average detection of 45% [4,5]. Granulomas are present in 25-40% of Crohn's disease biopsies at first presentation [6,7]. Detection is higher in children than adults [7,8], and the likelihood of finding granulomas increases with the more biopsies taken [4,6]. ...
... Granulomas are present in 25-40% of Crohn's disease biopsies at first presentation [6,7]. Detection is higher in children than adults [7,8], and the likelihood of finding granulomas increases with the more biopsies taken [4,6]. Granulomas are more commonly found in resection specimens than mucosal biopsies [4]. ...
... The prevalence appears to be higher in the paediatric age group [51]. Within the stomach, a sub-pattern of focally enhanced gastritis may provide a clue to the diagnosis (Fig. 5a); however, a diffuse pattern with granulomas is occasionally encountered in limited biopsies [7]. Gastric Crohn's disease is often accompanied by involvement of the other sites of the GI tract; therefore, an important step is to correlate with the finding of biopsies of other sites [7]. ...
Granulomas are organised collection of activated histiocytes induced by a persistent antigen stimulus. A wide variety of antigens encountered by the gastrointestinal tract are of this nature and hence the resulting granulomatous inflammation represents a tissue reaction pattern. The potential causes can be broadly classified as infections or non-infectious immune reactions. There is also a group where a cause is never identified. Granulomas may be of varying morphological appearance, most commonly epithelioid, foreign body type, suppurative and necrotizing. This may provide a clue as to the aetiology; however, in most cases, the cause requires further inquiry. Pathologists may need to cut deeper levels to look for foreign material and apply special stains to look for microorganisms. Pathologists also need to be certain that the process is a true granuloma and not a mimic. The site of occurrence in the gastrointestinal tract and the clinical setting is often paramount in establishing the aetiology. For instance, infections are more likely the cause in developing countries or when there is immunosuppression. Similarly, granulomas in the stomach are usually due to Crohn’s disease; however, it is only rarely the cause of granulomas isolated to the appendix.
... Dear Editor, We thank Doctors Villanacci and Bassotti for their kind comments and their interest in our paper [1]. We agree with their point that the diagnosis of Crohn's disease (CD) involving the upper gastrointestinal tract requires knowledge that Crohn's disease-related inflammation also exists in the terminal ileum and/or colon. ...
Histological assessment of endoscopic biopsies in inflammatory bowel disease [IBD] plays an important role in clinical management, investigative studies, and clinical trials. Scoring schemes consisting of multiple histological items and offering considerable precision are widely available. However, definitions of histological abnormalities are often inconsistent. Furthermore, interobserver variability for their recognition and assessment may be high.
The European Crohn’s and Colitis Organisation [ECCO] formed an expert panel to explore definitions of histological abnormalities in IBD, with the aim of improving the quality of diagnosis and facilitating development of scoring schemes. The process confirmed that the current definitions often have no evidence base and vary between sources. Using available evidence and expert knowledge, the panel produced a series of ECCO consensus position statements on histological features in IBD.
Background and aims:
To determine the incidence of inflammatory bowel disease (IBD) in the Mackay-Isaac-Whitsunday region in Northern Queensland (-21.14° S) and to allow a comparison with Southern Australian and New Zealand data (Geelong, Australia -38.14° S; Tasmania -41.43° S and -42.88° S (Launceston and Hobart) and Canterbury, New Zealand -43.46 °S).
Design:
A prospective observational community population-based IBD study was conducted between 1 June 2017 and 31 May 2018.
Outcome measures:
Primary includes the crude annual incidence rate of IBD, Crohn's disease (CD), ulcerative colitis (UC) and inflammatory bowel disease-unclassified (IBDU), while secondary includes disease phenotype and behaviour.
Results:
Fifty-six new cases of IBD were identified. Twenty-three were CD, 30 were UC and 3 were IBDU. The crude annual incidence rate per 100 000 for IBD, CD, UC and IBDU were 32.2 (95% confidence interval (CI): 24.78-41.84), 13.23 (95% CI: 8.79-19.90), 17.25 (95% CI: 12.06-24.67) and 1.73 (95% CI: 0.56-5.35). When directly age-standardised to the World Health Organisation Standard Population Distribution, the overall CD, UC and IBDU incidence were 13.19, 17.34 and 1.85 per 100 000, with an overall age-standardised IBD incidence of 32.38.
Conclusions:
This is the first study to define the incidence of IBD in a Northern Australian cohort and to allow a comparison between North and Southern Australia. The IBD crude is the highest reported in Australia. Like others, we found a high and low incidence of upper gastrointestinal Crohn's disease and complicated disease at diagnosis respectively, likely reflective of the increased availability and early uptake of endoscopic procedures.
Aims
Studies investigating the relationship between granulomatous gastritis (GG) and Helicobacter pylori infection have been largely inconclusive. This study was designed to determine whether the analysis of a very large number of patients would provide clearer answers evaluate the association between H. pylori infection and gastric granulomas.
Methods
We used a large national database of clinicopathological data to extract 1,673,086 patients who underwent esophagogastroduodenoscopy with gastric biopsies between 2008 and 2020. In a case‐control study, we evaluated the occurrence of H. pylori infection in patients with and without gastric granulomas. We also explored other clinical and histopathological associations.
Results
H. pylori infection was present in 44 of 496 (8.9%) patients with gastric granulomas, compared to 158,949 (9.5%) in the control group (OR = 0.93, 95% CI = 0.68–1.26). Of the 129 patients with gastric granulomas, 50 had documented inflammatory bowel disease.
Conclusions
The results of this study show that the prevalence of H. pylori infection in patients with gastric granulomas is essentially identical to that of controls with no evidence of granulomas or granulomatous disease. When patients with and without a plausible‐known association for gastric granulomas were analyzed separately, the prevalence of H. pylori infection remained remarkably similar in GG patients and controls. Considering the very large numbers of patients with gastric biopsies analyzed in this study, we submit that there is no basis for suggesting that H. pylori is etiologically related to GG.
Purpose of review:
A multitude of inflammatory diseases other than gastroesophageal reflux disease (GERD) and eosinophilic esophagitis can affect the esophagus. Despite the deceptively simple organization of squamous mucosa and its limited number of inflammatory responses, a wide array of histologic patterns can be seen in inflammatory disorders involving the esophagus. Each such histologic pattern is associated with a limited number of underlying conditions, and the clinician can use this information to narrow the differential diagnosis. The purpose of this review is to review and discuss the pathologic diagnosis of esophagitis caused by conditions other than GERD or eosinophilic esophagitis, with an emphasis on recent developments in the field.
Recent findings:
Recent studies suggest that lymphocytic esophagitis may be a histologic manifestation of esophageal motility disorders. Immunophenotypic features of infiltrating lymphocytes may be helpful in this scenario. immunoglobulin G4-related disease has been implicated as a cause of esophageal inflammation with ulceration, strictures, and mass-forming fibrosis, whereas epidermoid metaplasia has been linked molecularly to the squamous cell neoplasia pathway.
Summary:
Improved knowledge and appreciation of the pathology of esophageal inflammation are needed to better understand the pathogenesis of various types of esophagitis, and to inform new approaches to the therapy and management of inflammatory esophageal diseases.
This book concisely summarises non-neoplastic gastrointestinal (GI) pathology and provides histopathologists aiming to refresh or expand their knowledge with a practical approach to the interpretation of biopsies. It focuses on GI biopsies, but also covers the pathology of resections and other organs where appropriate. The editor and contributors bring their expertise as practicing diagnostic pathologists across Europe and the US. Examples of topics include inflammatory bowel disease, infections, vascular disorders, and inflammatory conditions specific to various anatomical sites. Fact sheets, practice points and tables facilitate rapid assimilation of information and enhance the reader's experience, and with additional access to the full online version, including expandable images on Cambridge Core, achieve accuracy every time. High-quality illustrations are also numerous, and references are relevant and reliable. This book is a practical, readable and up-to-date asset for any pathologist encountering GI biopsies.
This book concisely summarises non-neoplastic gastrointestinal (GI) pathology and provides histopathologists aiming to refresh or expand their knowledge with a practical approach to the interpretation of biopsies. It focuses on GI biopsies, but also covers the pathology of resections and other organs where appropriate. The editor and contributors bring their expertise as practicing diagnostic pathologists across Europe and the US. Examples of topics include inflammatory bowel disease, infections, vascular disorders, and inflammatory conditions specific to various anatomical sites. Fact sheets, practice points and tables facilitate rapid assimilation of information and enhance the reader's experience, and with additional access to the full online version, including expandable images on Cambridge Core, achieve accuracy every time. High-quality illustrations are also numerous, and references are relevant and reliable. This book is a practical, readable and up-to-date asset for any pathologist encountering GI biopsies.
This book concisely summarises non-neoplastic gastrointestinal (GI) pathology and provides histopathologists aiming to refresh or expand their knowledge with a practical approach to the interpretation of biopsies. It focuses on GI biopsies, but also covers the pathology of resections and other organs where appropriate. The editor and contributors bring their expertise as practicing diagnostic pathologists across Europe and the US. Examples of topics include inflammatory bowel disease, infections, vascular disorders, and inflammatory conditions specific to various anatomical sites. Fact sheets, practice points and tables facilitate rapid assimilation of information and enhance the reader's experience, and with additional access to the full online version, including expandable images on Cambridge Core, achieve accuracy every time. High-quality illustrations are also numerous, and references are relevant and reliable. This book is a practical, readable and up-to-date asset for any pathologist encountering GI biopsies.
