Benjamin Pariente1, Jean-Yves Mary2, Silvio Danese3, Yehuda Chowers4, Peter De Cruz5, Geert D'Haens6, Edward V Loftus7, Edouard Louis8, Julian Panés9, Jürgen Schölmerich10, Stefan Schreiber11, Maurizio Vecchi12, Julien Branche13, David Bruining7, Gionata Fiorino3, Matthias Herzog11, Michael A Kamm14, Amir Klein4, Maïté Lewin15, Paul Meunier16, Ingrid Ordas9, Ulrike Strauch10, Gian-Eugenio Tontini12, Anne-Marie Zagdanski17, Cristiana Bonifacio18, Jordi Rimola19, Maria Nachury13, Christophe Leroy20, William Sandborn21, Jean-Frédéric Colombel22, Jacques Cosnes23. 1. Department of Hepatogastroenterology, Hôpital Saint-Louis, Paris, France; Department of Hepatogastroenterology, University of Lille, Hôpital Claude Huriez, Lille, France. 2. INSERM U717, Biostatistics and Clinical Epidemiology, Hôpital Saint-Louis, Paris, France. 3. BD Center, Department of Gastroenterology, Istituto Clinico Humanitas, Rozzano, Milan, Italy. 4. Department of Gastroenterology, Rambam Health Care Campus, Haifa, Bat Galim, Israel. 5. St Vincent's Hospital & University of Melbourne, Melbourne, Australia. 6. Academic Medical Center, Amsterdam, The Netherlands; Imelda GI Clinical Research Center, Bonheiden, Belgium. 7. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. 8. Department of Hepatogastroenterology, Centre Hospitalier Universitaire de Liège, Liège University, Liège, Belgium. 9. Gastroenterology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain. 10. Department of Internal Medicine I, University of Regensburg, Regensburg, Germany. 11. Institute of Clinical Molecular Biology, Christian-Albrechts University, Kiel, Germany. 12. Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS Policlinico San Donato and University of Milan, Milan, Italy. 13. Department of Hepatogastroenterology, University of Lille, Hôpital Claude Huriez, Lille, France. 14. St Vincent's Hospital & University of Melbourne, Melbourne, Australia; Imperial College, London, UK. 15. Radiology Department, Hôpital Saint-Antoine, Paris, France. 16. Department of Medical Imaging, Centre Hospitalier Universitaire de Liège, Liège University, Liège, Belgium. 17. Radiology Department, Hôpital Saint-Louis, Paris, France. 18. Department of Radiology, Istituto Clinico Humanitas, Rozzano, Milan, Italy. 19. Radiology Department, CDI-Hospital Clinic, Barcelona, Spain. 20. Radiology Department, University Hospital, Lille, France. 21. Division of Gastroenterology, UC San Diego Health System, La Jolla, California. 22. Department of Gastroenterology, Icahn Medical School at Mount Sinai, New York, New York. 23. Gastroenterology and Nutrition Department, Hôpital Saint-Antoine, Paris, France. Electronic address: jacques.cosnes@sat.ap-hop-paris.fr.
Abstract
BACKGROUND & AIMS: There is a need for a scoring system that provides a comprehensive assessment of structural bowel damage, including stricturing lesions, penetrating lesions, and surgical resection, for measuring disease progression. We developed the Lémann Index and assessed its ability to measure cumulative structural bowel damage in patients with Crohn's disease (CD). METHODS: We performed a prospective, multicenter, international, cross-sectional study of patients with CD evaluated at 24 centers in 15 countries. Inclusions were stratified based on CD location and duration. All patients underwent clinical examination and abdominal magnetic resonance imaging analyses. Upper endoscopy, colonoscopy, and pelvic magnetic resonance imaging analyses were performed according to suspected disease locations. The digestive tract was divided into 4 organs and subsequently into segments. For each segment, investigators collected information on previous operations, predefined strictures, and/or penetrating lesions of maximal severity (grades 1-3), and then provided damage evaluations ranging from 0.0 (no lesion) to 10.0 (complete resection). Overall level of organ damage was calculated from the average of segmental damage. Investigators provided a global damage evaluation (from 0.0 to 10.0) using calculated organ damage evaluations. Predicted organ indexes and Lémann Index were constructed using a multiple linear mixed model, showing the best fit with investigator organ and global damage evaluations, respectively. An internal cross-validation was performed using bootstrap methods. RESULTS: Data from 138 patients (24, 115, 92, and 59 with upper tract, small bowel, colon/rectum, and anus CD location, respectively) were analyzed. According to validation, the unbiased correlation coefficients between predicted indexes and investigator damage evaluations were 0.85, 0.98, 0.90, 0.82 for upper tract, small bowel, colon/rectum, anus, respectively, and 0.84 overall. CONCLUSIONS: In a cross-sectional study, we assessed the ability of the Lémann Index to measure cumulative structural bowel damage in patients with CD. Provided further successful validation and good sensitivity to change, the index should be used to evaluate progression of CD and efficacy of treatment.
BACKGROUND & AIMS: There is a need for a scoring system that provides a comprehensive assessment of structural bowel damage, including stricturing lesions, penetrating lesions, and surgical resection, for measuring disease progression. We developed the Lémann Index and assessed its ability to measure cumulative structural bowel damage in patients with Crohn's disease (CD). METHODS: We performed a prospective, multicenter, international, cross-sectional study of patients with CD evaluated at 24 centers in 15 countries. Inclusions were stratified based on CD location and duration. All patients underwent clinical examination and abdominal magnetic resonance imaging analyses. Upper endoscopy, colonoscopy, and pelvic magnetic resonance imaging analyses were performed according to suspected disease locations. The digestive tract was divided into 4 organs and subsequently into segments. For each segment, investigators collected information on previous operations, predefined strictures, and/or penetrating lesions of maximal severity (grades 1-3), and then provided damage evaluations ranging from 0.0 (no lesion) to 10.0 (complete resection). Overall level of organ damage was calculated from the average of segmental damage. Investigators provided a global damage evaluation (from 0.0 to 10.0) using calculated organ damage evaluations. Predicted organ indexes and Lémann Index were constructed using a multiple linear mixed model, showing the best fit with investigator organ and global damage evaluations, respectively. An internal cross-validation was performed using bootstrap methods. RESULTS: Data from 138 patients (24, 115, 92, and 59 with upper tract, small bowel, colon/rectum, and anus CD location, respectively) were analyzed. According to validation, the unbiased correlation coefficients between predicted indexes and investigator damage evaluations were 0.85, 0.98, 0.90, 0.82 for upper tract, small bowel, colon/rectum, anus, respectively, and 0.84 overall. CONCLUSIONS: In a cross-sectional study, we assessed the ability of the Lémann Index to measure cumulative structural bowel damage in patients with CD. Provided further successful validation and good sensitivity to change, the index should be used to evaluate progression of CD and efficacy of treatment.
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