Endoscopic and Histopathological Characteristics of Newly Diagnosed Crohn's Disease in Vietnam: Insights From a Tertiary IBD Center

Background and aims: Crohn's disease (CD) is rapidly emerging in Asia, yet endoscopic and histopathological characteristics at diagnosis remain poorly described in Southeast Asia. We aimed to describe baseline endoscopic and histologic features in Vietnamese adults with newly diagnosed CD.

Methods

We conducted a descriptive cross-sectional study of consecutive adults newly diagnosed with CD from June 2019 to June 2024 at a tertiary inflammatory bowel disease (IBD) center in Vietnam. Ileocolonoscopy with segmental biopsies was performed in all patients. Endoscopic findings, histopathology, and Montreal classification were systematically recorded.

Results

Eighty patients (median age 34.5 years, 62.5% male) were included. The median time from symptom onset to diagnosis was 12 months (IQR 2-24); 78.8% had ≥ 1 prior inconclusive colonoscopy, and 25% had undergone intestinal resection before confirmed diagnosis. Ileocolonic disease (L3) predominated (71.3%). At diagnosis, 28.8% of patients had stricturing and 28.8% had penetrating disease behavior. Endoscopically, terminal ileal involvement was observed in 77.6%, cecal involvement in 56.6%, and skip lesions in 72.4%. Aphthous ulcers were seen in 13.2%, longitudinal ulcers in 14.5%, and cobblestoning in 6.6%. Luminal narrowing and fistulous openings were seen in 32.9% and 5.3%, respectively. The overall endoscopic impression was consistent with CD in 46.1%, non-specific in 35.5%, suggestive of colorectal cancer (CRC) in 13.2%, and suggestive of intestinal tuberculosis in 3.9%. Histologically, chronic inflammation was universal and non-caseating epithelioid granulomas were identified in 31.6%. The pathologist's conclusion was consistent with CD in 67.1% and non-specific in 30.4%.