Bowel Damage as Assessed by the Lémann Index is Reversible on Anti-TNF Therapy for Crohn’s Disease

Fiorino, Gionata; Bonifacio, Cristiana; Allocca, Mariangela; Repici, Alessandro; Balzarini, Luca; Malesci, Alberto; Peyrin–Biroulet, Laurent; Danese, Silvio

doi:10.1093/ecco-jcc/jjv080

Cited by 67 publications

(43 citation statements)

References 29 publications

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“…This index was designed as an evaluative tool which may in the future allow the longitudinal assessment of various medical therapies on disease progression, and permit identification of patients at high risk for progressive bowel damage . Importantly, the Lémann index can be reduced with anti‐TNF therapy, highlighting that biologics may be able to reverse bowel damage in some CD patients . Recently, a study showed that the presence of bowel damage in early CD was likely previously underestimated, probably because cross‐sectional imaging has been historically underused .…”

Section: Organ Damagementioning

confidence: 99%

Review article: moving towards common therapeutic goals in Crohn's disease and rheumatoid arthritis

Allen

Olivera

Emery

et al. 2017

Aliment Pharmacol Ther

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Novel therapeutic strategies in CD based on tight control of objective signs of inflammation are expected to change disease course and patients' lives by halting progression or, ideally, preventing the occurrence of bowel damage. Most of these strategies require validation in prospective studies, whereas several disease-modification trials have addressed these issues in rheumatoid arthritis over the last decade. The recent approval of new drugs in CD such as vedolizumab and ustekinumab should facilitate initiation of disease-modification trials in CD in the near future.

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Section: Organ Damagementioning

confidence: 99%

Review article: moving towards common therapeutic goals in Crohn's disease and rheumatoid arthritis

Allen

Olivera

Emery

et al. 2017

Aliment Pharmacol Ther

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“…(8) The Lémann Index might be a powerful tool to measure the impact of therapeutic strategies on long‐term outcomes in CD, in particular to prevent the progression of bowel damage. (9,10) The IBD Disability Index was developed to quantify disability in a patient with IBD at a given time. (7) The French version of the IBD Disability Index was recently validated.…”

Section: Introductionmentioning

confidence: 99%

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

Prevost

Azahaf

Nachury

et al. 2020

Aliment Pharmacol Ther

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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.

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“…In the past years, there has been increasing evidence that treating patients more aggressively earlier in the disease course, the so-called "top-down" treatment strategy, may prevent the development of IBD-related complications [6][7][8] . Moreover, recent studies proposed that an early diagnosis of IBD or an early treatment with TNF antagonists was associated with a reduced risk for developing complications of IBD [9,10] .…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for the Development of Fistulae and Stenoses in Crohn Disease Patients in the Swiss Inflammatory Bowel Disease Cohort

et al. 2016

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Background: Fistulae and stenoses represent frequent and severe complications in patients with Crohn disease (CD). Our study aimed to identify risk factors for fistula and stenosis formation in CD patients. Summary: We retrieved data of 1,600 CD patients from the nationwide Swiss Inflammatory Bowel Disease Cohort Study (SIBDCS). The risk for fistulae and stenoses in relation to gender, age at diagnosis, smoking status at diagnosis, and ileal involvement at diagnosis were analyzed. In the multivariate analysis, female gender showed a lower risk for developing perianal and any fistula (risk ratio [RR] 0.721, 95% confidence interval [CI] 0.582-0.893, p = 0.003 and RR 0.717, 95% CI 0.580-0.888, p = 0.002, respectively), and older age at diagnosis showed a lower risk for developing perianal fistula (RR 0.661, 95% CI 0.439-0.995, p = 0.047). Furthermore, ileal involvement was associated with a lower risk for perianal fistula (RR 0.713, 95% CI 0.561-0.906, p = 0.006), a lower risk for any fistula (RR 0.709, 95% CI 0.558-0.901, p = 0.005), and a higher risk for stenosis (RR 2.170, 95% CI 1.728-2.725, p < 0.001). Key Messages: In the nationwide SIBDCS, younger age at diagnosis and male gender were risk factors for developing perianal and nonperianal fistulae. Additionally, ileal involvement was revealed to be a potent risk factor (RR 2.170) for developing a stenosis.

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Bowel Damage as Assessed by the Lémann Index is Reversible on Anti-TNF Therapy for Crohn’s Disease

Abstract: The LI has good sensitivity to change. Anti-TNFs agents are able to reverse BD in some CD patients. BD progression as measured by the LI may be predictive of major abdominal surgery in these patients.

Cited by 67 publications

References 29 publications

Review article: moving towards common therapeutic goals in Crohn's disease and rheumatoid arthritis

Review article: moving towards common therapeutic goals in Crohn's disease and rheumatoid arthritis

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

Risk Factors for the Development of Fistulae and Stenoses in Crohn Disease Patients in the Swiss Inflammatory Bowel Disease Cohort

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