Benjamin Pariente1, Joana Torres2, Johan Burisch3, Naila Arebi4, Brigida Barberio5, Dana Duricova6, Pierre Ellul7, Adrian Goldis8, Ioannis Kaimakliotis9, Konstantinos Katsanos10, Željko Krznaric11, Deirdre McNamara12, Natalia Pedersen13, Shaji Sebastian14, Mustapha Azahaf15, Petra Weimers16, Philip Lung17, Carmelo Lacognata18, Martin Horak19, Dimitrios Christodoulou10, Viktor Domislovic11, Ian Murphy20, Jérôme Lambert21, Ryan Ungaro22, Jean-Frédéric Colombel22, Jean-Yves Mary21. 1. Hepato-Gastroenterology Department, Claude Huriez Hospital, University of Lille, Lille, France. Electronic address: benjamin.pariente@chru-lille.fr. 2. Division of Gastroenterology, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal. 3. Department of Gastroenterology, Medical Division, Hvidovre University Hospital, Hvidovre, Denmark. 4. Department of Inflammatory Bowel Disease, St Mark's Hospital and Imperial College London, London, United Kingdom. 5. Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy. 6. Inflammatory Bowel Diseases Clinical and Research Center, ISCARE a.s., Prague, Czech Republic; Institute of Pharmacology, First Faculty of Medicine, Charles University, Prague, Czech Republic. 7. Mater Dei Hospital, Department of Medicine, Division of Gastroenterology, Msida, Malta. 8. Department of Gastroenterology, University of Medicine, Timișoara, România. 9. American Gastroenterology Center, Cyprus. 10. Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine University of Ioannina School of Health Sciences, Ioannina, Greece. 11. Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre Zagreb, Zagreb, Croatia. 12. TAGG Research Centre, School of Medicine, Trinity College Dublin, Dublin, Ireland. 13. Department of Gastroenterology, Slagelse Hospital, Slagelse, Denmark. 14. Inflammatory Bowel Diseases Unit, Hull University Teaching Hospitals National Health Service Trust, Hull, United Kingdom. 15. Radiology Department, Claude Huriez hospital, University of Lille, Lille, France. 16. Department of Gastroenterology, North Zealand University Hospital, Capital Region, Denmark. 17. Radiology Department, St Mark's Hospital and Imperial College, London, United Kingdom. 18. Radiology Unit, University of Padova, Padova, Italy. 19. Department of Radiology, Na Homolce Hospital, Prague, Czech Republic. 20. Department of Radiology, Tallaght University Hospital, Dublin, Ireland. 21. INSERM U1135 Centre de Recherche Epidémiologie et Statistiques, Equipe Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments, Université de Paris, Hôpital Saint-Louis, Paris, France. 22. Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
Abstract
BACKGROUND & AIMS: The Lémann Index is a tool measuring cumulative structural bowel damage in Crohn's disease (CD). We reported on its validation and updating. METHODS: This was an international, multicenter, prospective, cross-sectional observational study. At each center, 10 inclusions, stratified by CD duration and location, were planned. For each patient, the digestive tract was divided into 4 organs, upper tract, small bowel, colon/rectum, anus, and subsequently into segments, explored systematically by magnetic resonance imaging and by endoscopies in relation to disease location. For each segment, investigators retrieved information on previous surgical procedures, identified predefined strictures and penetrating lesions of maximal severity (grades 1-3) at each organ investigational method (gastroenterologist and radiologist for magnetic resonance imaging), provided segmental damage evaluation ranging from 0.0 to 10.0 (complete resection). Organ resection-free cumulative damage evaluation was then calculated from the sum of segmental damages. Then investigators provided a 0-10 global damage evaluation from the 4-organ standardized cumulative damage evaluations. Simple linear regressions of investigator damage evaluations on their corresponding Lémann Index were studied, as well as calibration plots. Finally, updated Lémann Index was derived through multiple linear mixed models applied to combined development and validation samples. RESULTS: In 15 centers, 134 patients were included. Correlation coefficients between investigator damage evaluations and Lémann Indexes were >0.80. When analyzing data in 272 patients from both samples and 27 centers, the unbiased correlation estimates were 0.89, 0,97, 0,94, 0.81, and 0.91 for the 4 organs and globally, and stable when applied to one sample or the other. CONCLUSIONS: The updated Lémann Index is a well-established index to assess cumulative bowel damage in CD that can be used in epidemiological studies and disease modification trials.
BACKGROUND & AIMS: The Lémann Index is a tool measuring cumulative structural bowel damage in Crohn's disease (CD). We reported on its validation and updating. METHODS: This was an international, multicenter, prospective, cross-sectional observational study. At each center, 10 inclusions, stratified by CD duration and location, were planned. For each patient, the digestive tract was divided into 4 organs, upper tract, small bowel, colon/rectum, anus, and subsequently into segments, explored systematically by magnetic resonance imaging and by endoscopies in relation to disease location. For each segment, investigators retrieved information on previous surgical procedures, identified predefined strictures and penetrating lesions of maximal severity (grades 1-3) at each organ investigational method (gastroenterologist and radiologist for magnetic resonance imaging), provided segmental damage evaluation ranging from 0.0 to 10.0 (complete resection). Organ resection-free cumulative damage evaluation was then calculated from the sum of segmental damages. Then investigators provided a 0-10 global damage evaluation from the 4-organ standardized cumulative damage evaluations. Simple linear regressions of investigator damage evaluations on their corresponding Lémann Index were studied, as well as calibration plots. Finally, updated Lémann Index was derived through multiple linear mixed models applied to combined development and validation samples. RESULTS: In 15 centers, 134 patients were included. Correlation coefficients between investigator damage evaluations and Lémann Indexes were >0.80. When analyzing data in 272 patients from both samples and 27 centers, the unbiased correlation estimates were 0.89, 0,97, 0,94, 0.81, and 0.91 for the 4 organs and globally, and stable when applied to one sample or the other. CONCLUSIONS: The updated Lémann Index is a well-established index to assess cumulative bowel damage in CD that can be used in epidemiological studies and disease modification trials.
Authors: Simon P L Travis; Dan Schnell; Piotr Krzeski; Maria T Abreu; Douglas G Altman; Jean-Frédéric Colombel; Brian G Feagan; Stephen B Hanauer; Gary R Lichtenstein; Philippe R Marteau; Walter Reinisch; Bruce E Sands; Bruce R Yacyshyn; Patrick Schnell; Christian A Bernhardt; Jean-Yves Mary; William J Sandborn Journal: Gastroenterology Date: 2013-07-25 Impact factor: 22.682
Authors: J Rimola; S Rodriguez; O García-Bosch; I Ordás; E Ayala; M Aceituno; M Pellisé; C Ayuso; E Ricart; L Donoso; J Panés Journal: Gut Date: 2009-01-09 Impact factor: 23.059
Authors: Benjamin Pariente; Jean-Yves Mary; Silvio Danese; Yehuda Chowers; Peter De Cruz; Geert D'Haens; Edward V Loftus; Edouard Louis; Julian Panés; Jürgen Schölmerich; Stefan Schreiber; Maurizio Vecchi; Julien Branche; David Bruining; Gionata Fiorino; Matthias Herzog; Michael A Kamm; Amir Klein; Maïté Lewin; Paul Meunier; Ingrid Ordas; Ulrike Strauch; Gian-Eugenio Tontini; Anne-Marie Zagdanski; Cristiana Bonifacio; Jordi Rimola; Maria Nachury; Christophe Leroy; William Sandborn; Jean-Frédéric Colombel; Jacques Cosnes Journal: Gastroenterology Date: 2014-09-21 Impact factor: 22.682
Authors: Benjamin Pariente; Jacques Cosnes; Silvio Danese; William J Sandborn; Maïté Lewin; Joel G Fletcher; Yehuda Chowers; Geert D'Haens; Brian G Feagan; Toshifumi Hibi; Daniel W Hommes; E Jan Irvine; Michael A Kamm; Edward V Loftus; Edouard Louis; Pierre Michetti; Pia Munkholm; Tom Oresland; Julian Panés; Laurent Peyrin-Biroulet; Walter Reinisch; Bruce E Sands; Juergen Schoelmerich; Stefan Schreiber; Herbert Tilg; Simon Travis; Gert van Assche; Maurizio Vecchi; Jean-Yves Mary; Jean-Frédéric Colombel; Marc Lémann Journal: Inflamm Bowel Dis Date: 2010-11-28 Impact factor: 5.325