TY - JOUR
T1 - Development of the Lémann index to assess digestive tract damage in patients with Crohn's disease
AU - Pariente, Benjamin
AU - Mary, Jean Yves
AU - Danese, Silvio
AU - Chowers, Yehuda
AU - De Cruz, Peter
AU - D'Haens, Geert
AU - Loftus, Edward V.
AU - Louis, Edouard
AU - Panés, Julian
AU - Schölmerich, Jürgen
AU - Schreiber, Stefan
AU - Vecchi, Maurizio
AU - Branche, Julien
AU - Bruining, David
AU - Fiorino, Gionata
AU - Herzog, Matthias
AU - Kamm, Michael A.
AU - Klein, Amir
AU - Lewin, Maïté
AU - Meunier, Paul
AU - Ordas, Ingrid
AU - Strauch, Ulrike
AU - Tontini, Gian Eugenio
AU - Zagdanski, Anne Marie
AU - Bonifacio, Cristiana
AU - Rimola, Jordi
AU - Nachury, Maria
AU - Leroy, Christophe
AU - Sandborn, William
AU - Colombel, Jean Frédéric
AU - Cosnes, Jacques
N1 - Publisher Copyright:
© 2015 AGA Institute.
PY - 2015/1/1
Y1 - 2015/1/1
N2 - BACKGROUND & AIMS: There is a need for a scoring system that provides a comprehensive assessment of structural bowel damage, including stricturing lesions, penetrating lesions, and surgical resection, for measuring disease progression. We developed the Lémann Index and assessed its ability to measure cumulative structural bowel damage in patients with Crohn's disease (CD). METHODS: We performed a prospective, multicenter, international, cross-sectional study of patients with CD evaluated at 24 centers in 15 countries. Inclusions were stratified based on CD location and duration. All patients underwent clinical examination and abdominal magnetic resonance imaging analyses. Upper endoscopy, colonoscopy, and pelvic magnetic resonance imaging analyses were performed according to suspected disease locations. The digestive tract was divided into 4 organs and subsequently into segments. For each segment, investigators collected information on previous operations, predefined strictures, and/or penetrating lesions of maximal severity (grades 1-3), and then provided damage evaluations ranging from 0.0 (no lesion) to 10.0 (complete resection). Overall level of organ damage was calculated from the average of segmental damage. Investigators provided a global damage evaluation (from 0.0 to 10.0) using calculated organ damage evaluations. Predicted organ indexes and Lémann Index were constructed using a multiple linear mixed model, showing the best fit with investigator organ and global damage evaluations, respectively. An internal cross-validation was performed using bootstrap methods. RESULTS: Data from 138 patients (24, 115, 92, and 59 with upper tract, small bowel, colon/rectum, and anus CD location, respectively) were analyzed. According to validation, the unbiased correlation coefficients between predicted indexes and investigator damage evaluations were 0.85, 0.98, 0.90, 0.82 for upper tract, small bowel, colon/rectum, anus, respectively, and 0.84 overall. CONCLUSIONS: In a cross-sectional study, we assessed the ability of the Lémann Index to measure cumulative structural bowel damage in patients with CD. Provided further successful validation and good sensitivity to change, the index should be used to evaluate progression of CD and efficacy of treatment.
AB - BACKGROUND & AIMS: There is a need for a scoring system that provides a comprehensive assessment of structural bowel damage, including stricturing lesions, penetrating lesions, and surgical resection, for measuring disease progression. We developed the Lémann Index and assessed its ability to measure cumulative structural bowel damage in patients with Crohn's disease (CD). METHODS: We performed a prospective, multicenter, international, cross-sectional study of patients with CD evaluated at 24 centers in 15 countries. Inclusions were stratified based on CD location and duration. All patients underwent clinical examination and abdominal magnetic resonance imaging analyses. Upper endoscopy, colonoscopy, and pelvic magnetic resonance imaging analyses were performed according to suspected disease locations. The digestive tract was divided into 4 organs and subsequently into segments. For each segment, investigators collected information on previous operations, predefined strictures, and/or penetrating lesions of maximal severity (grades 1-3), and then provided damage evaluations ranging from 0.0 (no lesion) to 10.0 (complete resection). Overall level of organ damage was calculated from the average of segmental damage. Investigators provided a global damage evaluation (from 0.0 to 10.0) using calculated organ damage evaluations. Predicted organ indexes and Lémann Index were constructed using a multiple linear mixed model, showing the best fit with investigator organ and global damage evaluations, respectively. An internal cross-validation was performed using bootstrap methods. RESULTS: Data from 138 patients (24, 115, 92, and 59 with upper tract, small bowel, colon/rectum, and anus CD location, respectively) were analyzed. According to validation, the unbiased correlation coefficients between predicted indexes and investigator damage evaluations were 0.85, 0.98, 0.90, 0.82 for upper tract, small bowel, colon/rectum, anus, respectively, and 0.84 overall. CONCLUSIONS: In a cross-sectional study, we assessed the ability of the Lémann Index to measure cumulative structural bowel damage in patients with CD. Provided further successful validation and good sensitivity to change, the index should be used to evaluate progression of CD and efficacy of treatment.
KW - Illness Index Severity
KW - MRI
KW - Prognosis
KW - Response to Therapy
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U2 - 10.1053/j.gastro.2014.09.015
DO - 10.1053/j.gastro.2014.09.015
M3 - Article
C2 - 25241327
AN - SCOPUS:84922952083
SN - 0016-5085
VL - 148
SP - 52-63.e3
JO - Gastroenterology
JF - Gastroenterology
IS - 1
ER -