Granulomatous Gastritis in Crohn’s Disease - is it Common or Rare: Review Article

Abstract

Background: Granulomas in gastric biopsy specimens are extremely rare; more than half are associated with Crohn’s disease. In Crohn’s disease, clinical involvement is rare; microscopic disease is more common. Gastric granulomas are found in 9-15%, and a high proportion of Crohn’s patients show upper GI involvement, usually antral. Focal acute inflammation in a background of non-inflamed H. pylori negative mucosa is suggestive of Crohn’s disease and active inflammation in 56% (some inflammatory changes in up to 70%), but only 10% are H. pylori positive. Objective: The aim of the study was to highlight granulomatous gastritis in Crohn’s disease. Conclusion: The incidence of gastric Crohn’s is 10% of the cases. The histological diagnosis of Crohn’s disease on gastric samples is suggested by the presence of 1) a focal distribution; 2) chronic active inflammatory lesions; 3) the absence of the Helicobacter Pylori (HP) organism; and 4) granuloma. Focal stromal abnormalities could be a new diagnostic morphologic pattern in gastric Crohn’s disease, sharing the same value as focal cryptal architectural abnormalities in intestinal involvement. Since the majority of patients with Crohn’s disease lack significant symptoms, the true incidence of the disease depends on whether such pictures are sought for and identified. Keywords: Granulomatous Gastritis, Crohn’s disease, Chronic inflammatory condition