IMPORTANCE OF CRYPTOLYTIC LESIONS AND PERICRYPTAL GRANULOMAS IN INFLAMMATORY BOWEL-DISEASE

Aims--To explore the diagnostic importance of pericryptal granulomas a ssociated with epithelial lysis in colorectal biopsy specimens (crypto lytic colitis). Methods--A series of patients with suspected inflammat ory bowel disease and colorectal biopsy specimens showing either isola ted pericryptal granulomas (14 cases) or non-granulomatous pericryptal inflammation (eight cases) were followed. A diagnosis of Crohn's dise ase was established if subsequent biopsy specimens or intestinal resec tions showed unequivocal non-crypt related granulomas, or if there was evidence of significant small bowel disease. Results--Of the 14 patie nts with pericryptal granulomas and biopsy specimens, 10 were subseque ntly found to have Crohn's disease; of the eight patients with pericry ptal inflammation only, one developed Crohn's disease. The former grou p also had a much higher instance of morbidity and required surgical i ntervention more often. Conclusions--The presence of cryptolytic granu lomas in a colorectal biopsy specimen otherwise showing only non-speci fic inflammatory changes should always raise suspicion of Crohn's dise ase, especially if surgery or ileo-anal pouch formation is contemplate d.