Cyrielle Gilletta1, Maïté Lewin2, Anne Bourrier3, Isabelle Nion-Larmurier3, Sylvie Rajca3, Laurent Beaugerie3, Harry Sokol3, Benjamin Pariente4, Philippe Seksik3, Jacques Cosnes5. 1. Department of Gastroenterology, Centre Hospitalo-Universitaire de Caen, France. 2. Department of Radiology, Paul-Brousse Hospital, Villejuif, France. 3. Department of Gastroenterology, Saint Antoine Hospital, Paris, France; Department of Gastroenterology, Saint Antoine Hospital, Assistance Publique Hôpitaux de Paris and Paris VI University, Paris, France. 4. Department of Gastroenterology, Centre Hospitalo-Universitaire de Lille, France. 5. Department of Gastroenterology, Saint Antoine Hospital, Paris, France; Department of Gastroenterology, Saint Antoine Hospital, Assistance Publique Hôpitaux de Paris and Paris VI University, Paris, France. Electronic address: jacques.cosnes@sat.aphp.fr.
Abstract
BACKGROUND & AIMS: Stricturing or penetrating lesions develop over time in most patients with Crohn's disease. The Lémann Index indicates the degree of digestive damage at a given time in an individual. We tracked changes in Lémann Index scores in an inception cohort of patients and looked for factors associated with digestive damage. METHODS: We studied 221 patients diagnosed with Crohn's disease from 2004 through 2011 who received 2 or 3 serial morphologic evaluations over a period of 2 to 10 years. We collected cross-sectional images and had them reviewed by a gastroenterologist and a radiologist; Lémann index scores were calculated. A value of 2 was chosen as the cut-off value for substantial transparietal damage. Factors associated with a score greater than 2 at the last evaluation and progression of index scores were identified using univariate analysis and logistic regression analyses. RESULTS: The median index Lémann Index scores were 2.3 (interquartile range [IQR], 1.2-3.9) at first evaluation, 3.5 (IQR, 1.2-8.6) at 2 to 5 years after diagnosis, and 8.3 (IQR, 1.2-12.1) at 5 to 10 years after diagnosis. Index scores increased significantly at each stage compared with initial or previous values (P < .0001). After 73 months (IQR, 51-96 mo) of follow-up evaluation, 138 patients had a Lémann Index score greater than 2.0. The only early factor that predicted later damage was the first index value. Intestinal resection, time, and the percentage of time elapsed with a clinically active disease were associated with progressing damage. CONCLUSIONS: Based on an analysis of patients with Crohn's disease using the Lémann Index, nearly two thirds had substantial mucosal damage 2 to 10 years after diagnosis. High Lémann index scores at the first evaluation, time, persistent clinical activity, and intestinal resection are associated with damage.
BACKGROUND & AIMS: Stricturing or penetrating lesions develop over time in most patients with Crohn's disease. The Lémann Index indicates the degree of digestive damage at a given time in an individual. We tracked changes in Lémann Index scores in an inception cohort of patients and looked for factors associated with digestive damage. METHODS: We studied 221 patients diagnosed with Crohn's disease from 2004 through 2011 who received 2 or 3 serial morphologic evaluations over a period of 2 to 10 years. We collected cross-sectional images and had them reviewed by a gastroenterologist and a radiologist; Lémann index scores were calculated. A value of 2 was chosen as the cut-off value for substantial transparietal damage. Factors associated with a score greater than 2 at the last evaluation and progression of index scores were identified using univariate analysis and logistic regression analyses. RESULTS: The median index Lémann Index scores were 2.3 (interquartile range [IQR], 1.2-3.9) at first evaluation, 3.5 (IQR, 1.2-8.6) at 2 to 5 years after diagnosis, and 8.3 (IQR, 1.2-12.1) at 5 to 10 years after diagnosis. Index scores increased significantly at each stage compared with initial or previous values (P < .0001). After 73 months (IQR, 51-96 mo) of follow-up evaluation, 138 patients had a Lémann Index score greater than 2.0. The only early factor that predicted later damage was the first index value. Intestinal resection, time, and the percentage of time elapsed with a clinically active disease were associated with progressing damage. CONCLUSIONS: Based on an analysis of patients with Crohn's disease using the Lémann Index, nearly two thirds had substantial mucosal damage 2 to 10 years after diagnosis. High Lémann index scores at the first evaluation, time, persistent clinical activity, and intestinal resection are associated with damage.
Authors: Bhavana B Rao; Benjamin H Click; Ioannis E Koutroubakis; Claudia Ramos Rivers; Miguel Regueiro; Jason Swoger; Marc Schwartz; Jana Hashash; Arthur Barrie; Michael A Dunn; David G Binion Journal: Inflamm Bowel Dis Date: 2017-01 Impact factor: 5.325
Authors: Joana Torres; Flavio Caprioli; Konstantinos H Katsanos; Triana Lobatón; Dejan Micic; Marco Zerôncio; Gert Van Assche; James C Lee; James O Lindsay; David T Rubin; Remo Panaccione; Jean-Frédéric Colombel Journal: J Crohns Colitis Date: 2016-06-09 Impact factor: 9.071