Clinical Features, Diagnostic Findings, and Treatment Outcome of Patients with Granulomatous Intestinal Disease

Introduction Granulomas, focal aggregates of immune cells associated with chronic inflammation, are a key area of study. They can be categorized into foreign body granulomas, which isolate non-reactive substances without a T cell response, and immune granulomas, which involve continuous T cell-mediated reactions. Granulomas exhibit various patterns, such as foreign body, epithelioid, xanthogranulomatous, suppurative, and necrotizing types, each indicating different causes. They can result from infections such as TB, non-infectious conditions like Crohn’s disease, drug reactions, inherited disorders, malignancies, or idiopathic conditions. Accurate classification is crucial for effective management, ranging from antimicrobial therapy to immunosuppressive treatment. Despite challenges in granuloma distribution and morphology, histopathology remains essential for diagnosing intestinal granulomatous disease and differentiating between IBD subtypes and other conditions. Objectives The objective of this study is to understand patient’s clinical features, diagnostic findings, including histopathologic distribution of granulomas found in colonoscopy biopsies, and treatment outcome of patients that guides in early categorization and management selection of patients with granulomatous intestinal diseases. Methods and Materials A cross-sectional descriptive study was conducted at Tikur Anbessa Specialized Hospital (TASH) between June 1, 2024, and November 30, 2024. The study included patients with a presumed diagnosis of granulomatous disease. A systematic random sampling method was employed, with a calculated sample size of 108. Clinical, laboratory, colonoscopic, and histopathologic findings were analyzed using IBM SPSS Statistics, with significance determined at p < 0.05. Result and discussion This study provides a comprehensive analysis of patients diagnosed with Crohn's Disease (CD) and Tuberculosis (TB) at a gastrointestinal clinic over a six-month period. The findings reveal that a significant proportion of the study population were female (64%), with a mean age of 33.5 years. The average age of symptom onset was 30.8 years, indicating that symptoms typically manifest in the late twenties to early thirties. A notable proportion of patients had a history of prior surgery (33.7%) and TB (15.7%). Most patients (76.4%) were diagnosed with CD, while 16.9% were diagnosed with TB. Diagnostic methods included colonoscopy (37%) and histopathology (34.5%). Abdominal pain was the most common presenting symptom (68.8%), followed by chronic diarrhea without blood (12.9%) and anorectal pain (10.8%). During follow-up, 21% of cases experienced a change in diagnosis, with 18% reclassified as CD and 2% as intestinal TB. Over half of the patients (56%) were hospitalized for their condition. Initial treatment patterns revealed that 47% of patients started on steroids, 32% on immunomodulators, and 15% on anti-TB treatment. A significant proportion (41.6%) underwent surgery during follow-up. Histologic findings highlighted the presence of increased inflammatory cells and granulomas. Imaging findings, particularly bowel wall thickening and unremarkable ultrasound results, were significant in differentiating CD from non-CD conditions.