Crohn's Disease Features in Anastomotic Biopsies from Patients With and Without Crohn's Disease: Diagnostic and Prognostic Value

被引:1
作者
Evaristo, Gertruda [1 ]
Szczepanski, Julianne [2 ]
Farag, Mina S. [3 ]
Rubin, David T. [4 ]
Campbell, Lucas K. [5 ]
Marcus, Victoria A. [3 ]
Lamps, Laura W. [2 ]
Hart, John [1 ]
机构
[1] Univ Chicago, Dept Pathol, Chicago, IL 60637 USA
[2] Univ Michigan, Dept Pathol, Ann Arbor, MI USA
[3] McGill Univ, Dept Pathol, Montreal, PQ, Canada
[4] Univ Chicago Med, Inflammatory Bowel Dis Ctr, Chicago, IL USA
[5] Northwest Arkansas Pathol Associates, Fayetteville, AR USA
关键词
Anastomotic biopsy; Crohn's disease; Endoscopy; gastrointestinal pathology; IBD; Inflammatory Bowel Disease; INFLAMMATORY-BOWEL-DISEASE; ACTIVITY INDEXES; THERAPY; REMISSION; MIMICS;
D O I
10.1016/j.modpat.2023.100325
中图分类号
R36 [病理学];
学科分类号
100104 ;
摘要
Endoscopic evidence of disease activity is a critical predictor of clinical relapse in patients with Crohn's disease (CD), and histologic disease activity is evolving as a similarly important end point for patient management. However, classical morphologic features of CD may overlap with postoperative inflammatory changes, confounding the evaluation of anastomotic biopsies. There is a clear unmet need for better characterization of diagnostic and clinically significant histologic features of CD in these surgically altered sites. We evaluated ileocolonic and colocolonic/rectal anastomotic biopsies performed at 3 academic institutions in patients with and without CD. The biopsies were blindly assessed for CD histologic features and correlated to clinical and endoscopic characteristics. In CD patients, the presence of each feature was correlated with the subsequent clinical exacerbation or relapse. We obtained anastomotic biopsies from 208 patients, of which 109 were operated on for CD and 99 for another indication (neoplasia [80%], diverticular disease (11%), and other [9%]). Mean time since surgery was 10 years (0-59; 14 years for CD [1-59], 6 years for non-CD [0-33]). Endoscopic inflammation was noted in 52% of cases (68% for CD and 35% for non-CD). Microscopic inflammation was present in 74% of cases (82% for CD and 67% for non-CD). Only discontinuous lymphoplasma-cytosis (P < .001) and pyloric gland metaplasia (P = .04) occurred significantly more often in CD patients. However, none of the histologic features predicted clinical disease progression. In subset analysis, the presence of histologic features of CD in nonanastomotic biopsies obtained concurrently in CD patients was significantly associated with relapse (P = .03). Due to extensive morphologic overlap between CD and postoperative changes and the lack of specific histologic features of relapse, biopsies from anastomotic sites are of no value in predicting clinical CD progression. Instead, CD activity in biopsies obtained away from anastomotic sites should be used for guiding endoscopic sampling and clinical management. (c) 2023 United States & Canadian Academy of Pathology. Published by Elsevier Inc. All rights reserved.
引用
收藏
页数:8
相关论文
共 50 条
[41]   Medical treatment of intestinal Crohn's disease [J].
Tetangco, Eula Plana C. ;
Stein, Adam .
SEMINARS IN COLON AND RECTAL SURGERY, 2022, 33 (01)
[42]   Plain abdominal radiographs in patients with Crohn's disease: Radiological findings and diagnostic value [J].
O'Regan, K. ;
O'Connor, O. J. ;
O'Neill, S. B. ;
Mc Laughlin, P. D. ;
Desmond, A. ;
McWilliams, S. R. ;
Quigley, E. M. M. ;
Shanahan, F. ;
Maher, M. M. .
CLINICAL RADIOLOGY, 2012, 67 (08) :774-781
[43]   The Role of Chronic Fatigue in Patients with Crohn's Disease [J].
Wlodarczyk, Marcin ;
Makaro, Adam ;
Prusisz, Mateusz ;
Wlodarczyk, Jakub ;
Nowocien, Marta ;
Marynczak, Kasper ;
Fichna, Jakub ;
Dziki, Lukasz .
LIFE-BASEL, 2023, 13 (08)
[44]   Efficacy of Adalimumab in Korean Patients with Crohn's Disease [J].
Sohn, Il Woong ;
Kim, Sung Tae ;
Kim, Bun ;
Lee, Hyun Jung ;
Park, Soo Jung ;
Hong, Sung Pil ;
Kim, Tae Il ;
Kim, Won Ho ;
Cheon, Jae Hee .
GUT AND LIVER, 2016, 10 (02) :255-261
[45]   Evaluation of diagnostic criteria for Crohn's disease in Japan [J].
Hisabe, Takashi ;
Hirai, Fumihito ;
Matsui, Toshiyuki ;
Watanabe, Mamoru .
JOURNAL OF GASTROENTEROLOGY, 2014, 49 (01) :93-99
[46]   Major acute bleeding in patients with Crohn's disease [J].
de Acosta, M. Barreiro ;
Rios, S. Seijo ;
Munoz, J. E. Dominguez .
REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS, 2007, 99 (07) :388-391
[47]   Evaluation of diagnostic criteria for Crohn’s disease in Japan [J].
Takashi Hisabe ;
Fumihito Hirai ;
Toshiyuki Matsui ;
Mamoru Watanabe .
Journal of Gastroenterology, 2014, 49 :93-99
[48]   Effects of Ustekinumab on Histologic Disease Activity in Patients With Crohn's Disease [J].
Li, Katherine ;
Friedman, Joshua R. ;
Chan, Daphne ;
Pollack, Paul ;
Yang, Feifei ;
Jacobstein, Douglas ;
Brodmerkel, Carrie ;
Gasink, Christopher ;
Feagan, Brian G. ;
Sandborn, William J. ;
Rutgeerts, Paul ;
De Hertogh, Gert .
GASTROENTEROLOGY, 2019, 157 (04) :1019-+
[49]   Spatial features of skip lesions in Crohn's disease [J].
Herren, Rachel ;
Geva-Zatorsky, Naama .
TRENDS IN IMMUNOLOGY, 2024, 45 (06) :470-481
[50]   The Predictive Value of Periostin to Diagnose Crohn's Disease [J].
Keskin, Muharrem ;
Topkac, Ali .
TURKISH JOURNAL OF GASTROENTEROLOGY, 2022, 33 (02) :127-135