Gionata Fiorino1, Mathilde Morin2, Stefanos Bonovas1, Cristiana Bonifacio3, Antonino Spinelli4,5, Adeline Germain6, Valérie Laurent7, Camille Zallot2, Laurent Peyrin-Biroulet2, Silvio Danese1,5. 1. IBD Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy. 2. Department of Hepato-Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France. 3. Radiology Unit, Humanitas Research Hospital, Humanitas Research Hospital, Rozzano, Milan, Italy. 4. Colon and Rectal Surgery Unit, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy. 5. Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy. 6. Department of Digestive Surgery, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France. 7. Department of Radiology, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France.
Abstract
BACKGROUND AND AIMS: Bowel damage in Crohn's disease [CD] is defined as the presence of intestinal strictures, fistulas or abscesses. Early disease may represent a window of opportunity for timely intervention. We evaluated disease activity and severity by the Lémann Index [LI] and the Magnetic Resonance Index of Activity [MaRIA] score, and their prognostic value in early CD. METHODS: All consecutive patients diagnosed with CD in two referral centres, assessed by magnetic resonance imaging or computerized tomography, were prospectively included. Disease activity and bowel damage in early CD, the correlation between the LI and the MaRIA score, and the value of cross-sectional imaging findings in predicting disease progression were assessed. Statistical analyses employed time-to-event methods. RESULTS: We included 142 consecutive CD patients. Median time from diagnosis to baseline imaging was 0.3 years; median follow-up time was 4.9 years. At diagnosis, 39.4% of CD patients had bowel damage. At multivariable analysis, bowel damage and the LI were independent prognostic factors for intestinal surgery (hazards ratio [HR]: 3.21 and 1.11, respectively, p<0.001), and of CD-related hospitalization during patient follow-up [HR: 1.88, p=0.002, and 1.08, p<0.001, respectively]. Disease activity as expressed by the MaRIA score did not predict the disease course. The correlation between the LI and MaRIA score was weak [rho: +0.32; p<0.001]. CONCLUSION: Four out of ten CD patients have bowel damage at the time of the first imaging study. The presence of bowel damage, and not the MaRIA score, in early CD is associated with a worse outcome, with increased risks of surgery and hospitalization.
BACKGROUND AND AIMS: Bowel damage in Crohn's disease [CD] is defined as the presence of intestinal strictures, fistulas or abscesses. Early disease may represent a window of opportunity for timely intervention. We evaluated disease activity and severity by the Lémann Index [LI] and the Magnetic Resonance Index of Activity [MaRIA] score, and their prognostic value in early CD. METHODS: All consecutive patients diagnosed with CD in two referral centres, assessed by magnetic resonance imaging or computerized tomography, were prospectively included. Disease activity and bowel damage in early CD, the correlation between the LI and the MaRIA score, and the value of cross-sectional imaging findings in predicting disease progression were assessed. Statistical analyses employed time-to-event methods. RESULTS: We included 142 consecutive CD patients. Median time from diagnosis to baseline imaging was 0.3 years; median follow-up time was 4.9 years. At diagnosis, 39.4% of CD patients had bowel damage. At multivariable analysis, bowel damage and the LI were independent prognostic factors for intestinal surgery (hazards ratio [HR]: 3.21 and 1.11, respectively, p<0.001), and of CD-related hospitalization during patient follow-up [HR: 1.88, p=0.002, and 1.08, p<0.001, respectively]. Disease activity as expressed by the MaRIA score did not predict the disease course. The correlation between the LI and MaRIA score was weak [rho: +0.32; p<0.001]. CONCLUSION: Four out of ten CD patients have bowel damage at the time of the first imaging study. The presence of bowel damage, and not the MaRIA score, in early CD is associated with a worse outcome, with increased risks of surgery and hospitalization.
Authors: Iago Rodríguez-Lago; Javier Del Hoyo; Alexandre Pérez-Girbés; Alejandro Garrido-Marín; María José Casanova; María Chaparro; Agnès Fernández-Clotet; Jesús Castro-Poceiro; María José García; Sara Sánchez; Rocío Ferreiro-Iglesias; Iria Bastón; Marta Piqueras; Lola Esteba I Bech de Careda; Raquel Mena; Cristina Suárez; Joaquín Poza Cordón; Alicia López-García; Lucía Márquez; Maite Arroyo; Erika Alfambra; Mónica Sierra; Noelia Cano; Pedro Delgado-Guillena; Víctor Morales-Alvarado; Juan Carlos Aparicio; Iván Guerra; Carolina Aulló; Olga Merino; Laura Arranz; María Araceli Hidalgo; Jordina Llaó; Rocío Plaza; Gema Molina; Paola Torres; Pablo Pérez-Galindo; María Giselle Romero; Claudia Herrera-deGuise; Edisa Armesto; Francisco Mesonero; Santiago Frago-Larramona; José Manuel Benítez; Marta Calvo; María Del Carmen López Martín; Ainara Elorza; Alejandro Larena; Elena Peña; María Del Carmen Rodríguez-Grau; Jaime de Miguel-Criado; Belén Botella; José Antonio Olmos; Laura López; Urko Aguirre; Javier P Gisbert Journal: United European Gastroenterol J Date: 2020-07-28 Impact factor: 4.623
Authors: Ryan W Stidham; Binu Enchakalody; Akbar K Waljee; Peter D R Higgins; Stewart C Wang; Grace L Su; Ashish P Wasnik; Mahmoud Al-Hawary Journal: Inflamm Bowel Dis Date: 2020-04-11 Impact factor: 5.325