Efficacy of early intervention on the bowel damage and intestinal surgery of Crohn’s disease, based on the Lémann index

Abstract

Background Clinicians aim to prevent progression of Crohn’s disease (CD); however, many patients require surgical resection because of cumulative bowel damage. The aim of this study was to evaluate the impact of early intervention on bowel damage in patients with CD using the Lémann Index and to identify bowel resection predictors. Methods We analyzed consecutive patients with CD retrospectively. The Lémann Index was determined at the point of inclusion and at follow-up termination. The Paris definition was used to subdivide patients into early and late CD groups. Results We included 154 patients, comprising 70 with early CD and 84 with late CD. After follow-up for 17.0 months, more patients experienced a decrease in the Lémann Index (61.4% vs. 42.9%), and fewer patients showed an increase in the Lémann Index (20% vs. 35.7%) in the early compared with the late CD group. Infliximab and other therapies reversed bowel damage to a greater extent in early CD patients than in late CD patients. Twenty-two patients underwent intestinal surgery, involving 5 patients in the early CD group and 17 patients in the late CD group. Three independent predictors of bowel resection were identified: baseline Lémann index ≥ 8.99, disease behavior B1, and history of intestinal surgery. Conclusions Early intervention within 18 months after CD diagnosis could reverse bowel damage and decrease short-term intestinal resection. Patients with CD with a history of intestinal surgery, and/or a Lémann index > 8.99 should be treated aggressively and monitored carefully to prevent progressive bowel damage.

Transmural cross-sectional findings and bowel damage assessment in preclinical Crohn’s disease: a case-control study

“…Observational studies have demonstrated that LI progressively increases since diagnosis [ 14 ], with median scores of 2.3 (IQR, 1.2–3.9) at first evaluation, 3.5 (IQR, 1.2–8.6) at 2 to 5 years after diagnosis, and 8.3 (IQR, 1.2–12.1) at 5 to 10 years after diagnosis [ 16 ]. It has also been shown as a prognostic marker, as higher scores at diagnosis predict the need of surgery during the first year [ 21 ], so it has been suggested that these cases should be proactively treated and monitored carefully to prevent progressive bowel damage [ 16 , 17 , 22 ]. Similar observations have been done even in patients considered as early CD (< 24 months disease duration with no previous medical therapy or surgery), in whom any relative increase on LI was associated with a worse prognosis [ 17 ].…”

A scoping review on early inflammatory bowel disease: definitions, pathogenesis, and impact on clinical outcomes

“…Throughout the years, several authors have evaluated the impact of targeting early CD on disease outcomes ( Table 1 ). Most of the available evidence comes from the use of anti-TNF drugs, either alone (22 12 – 21 , 23 – 25 , 29 , 31 , 32 , 34 , 35 , 36 , 37 , 38 , 41 out of 29 studies) or in combination with immunosuppressants (7 7 , 17 , 30 , 34 , 38 , 39 , 40 ); the single use of immunosuppressants was evaluated in five studies, 17 , 21 , 28 , 33 , 38 while vedolizumab was studied once. 22 Although ‘early disease’ definition and the outcomes sought varied widely, data from observational studies and from post-hoc analysis of RCTs have shown that patients who received therapy in the early stage of disease have better outcomes than those who received treatment later.…”

“… 14 , 21 , 41 Besides that, some authors have stated that intervention within 18 months after CD diagnosis may prevent and even reverse bowel damage. 40 On the other hand, the impact of early treatment on patients’ quality of life, work productivity, and disability remains largely unexplored.…”

Aspects Towards the Anastomotic Healing in Crohn’s Disease: Clinical Approach and Current Gaps in Research

“…The literature is controversial regarding the optimal timing of surgery. Even the period that is taken into account to define a surgical intervention as early is inconstant, varying from 6 to 18 months after CD diagnosis (18,19). Earlier surgical approaches would be related to the performance of technically easier procedures, smaller resections and consequently lower postoperative complications.…”