Changes in the Lémann Index Values During the First Years of Crohn’s Disease

Gilletta, Cyrielle; Lewin, M.; Bourrier, Anne; Nion–Larmurier, Isabelle; Rajca, Sylvie; Beaugerie, Laurent; Sokol, Harry; Pariente, Benjamin; Seksik, Philippe; Cosnes, Jacques

doi:10.1016/j.cgh.2015.02.041

Cited by 47 publications

(26 citation statements)

References 18 publications

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“…(13) All the other studies of the Lémann Index are retrospective and the published methodology for calculating the Lémann Index was not applied. (10,14‐16) Our study, using the published methodology, confirms that the Lémann Index increases with disease duration by assessing irreversible bowel damage as well as the accumulation of stricturing lesions, penetrating lesions and surgical resections. (8) Our results confirm that the Lémann Index identifies disease progression and we also identified other factors associated with more extensive bowel damage.…”

Section: Discussionsupporting

confidence: 62%

“…As previously reported by Giletta et al, we confirmed that intestinal resection and a complicated CD phenotype were associated with higher Lémann Index scores. (14) Finally, we showed that exposure to immunosuppressants and anti‐TNF treatments were associated with more extensive bowel damage. These results are logical, suggesting that the most powerful treatments are used in patients with the most aggressive disease.…”

Section: Discussionmentioning

confidence: 79%

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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

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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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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 79%

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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“…While use of serological and genetic markers in prognostication has been hampered by lack of sensitivity and lack of wide availability, these are of increasing clinical interest. Indeed, composite scores incorporating clinical information and molecular profiling, and considering harder endpoints such as bowel damage 115,116 and disability, 117 will hopefully allow us to better personalize therapy in the future, both at diagnosis and throughout the disease course. 118 …”

Section: Future Directionsmentioning

confidence: 99%

Predicting Outcomes to Optimize Disease Management in Inflammatory Bowel Diseases

Torres

Caprioli

Κατσάνος

et al. 2016

ECCOJC

119

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Background and Aims:Efforts to slow or prevent the progressive course of inflammatory bowel diseases [IBD] include early and intensive monitoring and treatment of patients at higher risk for complications. It is therefore essential to identify high-risk patients – both at diagnosis and throughout disease course.Methods:As a part of an IBD Ahead initiative, we conducted a comprehensive literature review to identify predictors of long-term IBD prognosis and generate draft expert summary statements. Statements were refined at national meetings of IBD experts in 32 countries and were finalized at an international meeting in November 2014.Results:Patients with Crohn’s disease presenting at a young age or with extensive anatomical involvement, deep ulcerations, ileal/ileocolonic involvement, perianal and/or severe rectal disease or penetrating/stenosing behaviour should be regarded as high risk for complications. Patients with ulcerative colitis presenting at young age, with extensive colitis and frequent flare-ups needing steroids or hospitalization present increased risk for colectomy or future hospitalization. Smoking status, concurrent primary sclerosing cholangitis and concurrent infections may impact the course of disease. Current genetic and serological markers lack accuracy for clinical use.Conclusions:Simple demographic and clinical features can guide the clinician in identifying patients at higher risk for disease complications at diagnosis and throughout disease course. However, many of these risk factors have been identified retrospectively and lack validation. Appropriately powered prospective studies are required to inform algorithms that can truly predict the risk for disease progression in the individual patient.

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“…While there is still debate regarding the content validity, inter rater reliability, ideal diagnostic modality for index calculation and efficient and effective incorporation of LI into clinical practice, LI has been shown to reflect disease course and shows worsening with persistent clinical activity (24) and improvement with anti-TNF therapy. (25) Change in LI or DLI has been demonstrated to be a useful tool to chart CD trajectory and segregate heterogeneous disease phenotypes.…”

Section: Discussionmentioning

confidence: 99%

The Cost of Crohnʼs Disease

Rao

Click

Koutroubakis

et al. 2017

Inflammatory Bowel Diseases

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Background Patients with Crohn's disease (CD) encompass a heterogeneous disease spectrum, with variable healthcare utilization and expenditure patterns. Lémann Index (LI) is a metric that quantifies cumulative bowel damage and has shown utility in delineating distinct disease phenotypes. Aim To characterize the financial burden from all medical care in a CD cohort in relation to variations in LI-based disease phenotypes. Methods CD patients with 5 year(y) follow-up from a prospective registry were included. LI was calculated from first (LI1) and last (LI2) clinical encounters. Change in score (LI2-LI1) or Delta LI (DLI) was used for association analysis with healthcare expenditures. Results A total of 243 CD patients formed the study population [median age 44y; 58% female; median disease duration 12y]. DLI was used to define disease trajectories: DLI<0 (indicating improving bowel damage); DLI=0 (stable); DLI>0 (worsening); which comprised 15.6%, 30.9% and 53.5% of the cohort respectively. Patients with DLI>0 had significantly higher CD-related surgeries, healthcare utilization, medication (steroids and biologics) use as well as higher median 5y total and stratified charges compared to the other groups. Total 5y expenditure was $56 million; 67% of which was related to hospitalization. Total expense showed independent positive correlation with LI2 (p=0.001) and DLI (p=0.001), and negative correlation with age (p=0.029) and 5y quality of life score (p=0.024). Conclusion The financial burden of CD is significantly associated with worsening bowel damage. Further research should focus on the prediction and management of the costliest/sickest CD patients.

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Changes in the Lémann Index Values During the First Years of Crohn’s Disease

Cited by 47 publications

References 18 publications

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

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

Predicting Outcomes to Optimize Disease Management in Inflammatory Bowel Diseases

The Cost of Crohnʼs Disease

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