Bowel damage and disability in Crohn's disease: a prospective study in a tertiary referral centre of the Lémann Index and Inflammatory Bowel Disease Disability Index

Abstract

Background: The notion of Crohn's disease (CD) as a chronic, progressive and disabling condition has led to the development of new indexes: the Lémann Index measuring cumulative bowel damage and the Inflammatory Bowel Disease (IBD) Disability Index, assessing functional disability.Aims: To measure the Lémann Index and the IBD Disability Index in a large prospective cohort of CD patients and to assess the correlation between these two indexes. Methods:We performed a prospective study in a tertiary referral centre including all consecutive CD outpatients. We assessed the Lémann Index and the IBD Disability Index questionnaire in all patients. Results:One hundred and thirty CD patients were consecutively included. The mean Lémann Index (±SD) was 11.9 ± 14.1 and ranged from 0 to 72.5 points. Factors associated with a high bowel damage score were: disease duration, anal location, previous intestinal resection, clinical and biological disease activity, exposure to immunosuppressants, and exposure to anti-TNF (P < 0.005). Among patients exposed to anti-TNF, the Lémann Index was lower in those who were exposed in the first 2 years of their disease (P = 0.015). The mean IBD Disability Index was 28.8 ± 6.3 and ranged from 0 to 71 points. The factors associated with high disability score were: female gender, anal location, extra digestive manifestations, clinical and biological disease activity and exposure to anti-TNF (P < 0.005). No correlation was observed between the Lémann Index and IBD Disability Index (P = 0.15). Conclusions:This is the first study to prospectively evaluate the Lémann Index and the IBD Disability Index in a large cohort of CD patients in a tertiary centre. Early introduction of anti-TNF treatment was associated with lower bowel damage scores, and no correlation was observed between the Lémann Index and the IBD Disability Index. Further dedicated prospective studies are necessary to confirm these results.

Editorial: the most commonly used IBD indices still fail to represent real life and subjective patient experience. Author’s reply

“…Drs Creemers, Bloem and Bodegraven also underlined that our result showing that there was no correlation between the Lémann index and the IBD Disability Index, is logical 4 . Indeed, the subjective aspect of the IBD Disability Index score is obvious because it measures disability which is correlated in part to quality of life 5,6 .…”

Diagnosis and natural history of preclinical and early inflammatory bowel disease

“…It has been shown to accurately parallel disease progression in CD [ 22 , 112 ], but evidence about its utility with the different treatments is still limited. Biologics, and specifically anti-TNFs, have been shown to be effective in stopping, and even reducing, cumulative damage as measured by this index [ 113 , 114 ]. However, more data are still needed about its application with the remaining drugs currently used in clinical practice.…”

Editorial: the most commonly used IBD indices still fail to represent real life and subjective patient experience

“…The study by Lauriot dit Prevost et al 1 showed that there was no (or limited) correlation between the Lémann index and the IBD‐DI. Hence intestinal damage and patient‐reported outcome (experience) assess different domains of a Crohn’s disease patient.…”

“…In a recent prospective study assessing the Lémann Index and the Inflammatory Bowel Disease‐Disability Index (IBD‐DI) in 130 outpatients with Crohn's disease, factors associated with extensive bowel damage and severe disability were identified 1 . Furthermore, the correlation between the Lémann Index, designed to objectify accumulative intestinal structural damage, and the IBD‐DI, being a patient‐reported outcome measure (PROM) of disease‐associated disability, was calculated.…”

“…This interesting paper 1 is an important step in determining how to deal with objective and subjective outcome measures in IBD. Both objective and subjective parameters remain important for registration and clinical purposes, as we intend to treat a patient, not a disease.…”