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DOP057 Evolution of the Lémann Index (LI) during the course of Crohn's disease (CD)

C. Gilletta1, M. Lewin2, P. Seksik1, A. Bourrier3, I. Nion-Larmurier4, H. Sokol2, L. Beaugerie5, B. Pariente6, J. Cosnes*1

1hopital St-Antoine, Gastroenterology, Paris, France, 2Hopital Saint-Antoine - APHP, Department of Gastroenterology, Paris, France, 3Hopital St Antoine , Gastroenterology , Paris, France, 4Hopital Saint Antoine, Gastroenterology , Paris, France, 5hopital saint-antoine, gastroenterology, Paris, France, 6CHU Lille, Gastroenterology, Lille, France

Background

Stricturing or penetrating lesions develop over time in most patients with CD leading eventually to surgical resection. The Lémann Index (LI) measures the digestive damage (DD). The aim of this study was to describe the evolution of LI in an incipient cohort of CD patients and to search for predictors of DD.

Methods

We studied 221 patients (114 M, 107 F, median age 24 yr [19-33]) diagnosed with CD between 2004 and 2011, followed up prospectively in our center, and who had 2 or 3 serial determinations of LI. Abdominal CT scan (n=204), abdominal MRI (n=332), and pelvic MRI (n=56) were re-read by a couple gastroenterologist and radiologist. LI was then calculated taking into account clinical and endoscopic data and radiological re-assessment. The cut-off of LI >2.0, corresponding to the 75th percentile value of pre-operative LI in patients led to surgery, was assigned to identify patients with a substantial DD. In addition we analysed intervals between 2 evaluations. Factors associated with DD and progression of LI during one interval were searched for using univariate analyis and logistic regression.

Results

Median LI (IQR) was 2.3 (1.2-3.9) at first evaluation, 3.9 (1.6-9.8) 2-5 yr after diagnosis, and 8.3 (1-12.3) at 5-10 yr. LI increased significantly (p< 0.0001) at 2-5 yr and 5-10 yr compared to its initial value and from 2-5 yr to 5-10 yr. Last value of LI after 73 months (51-96) was >2.0 in 138 patients (63%). These patients did not differ from those without DD regarding demographic data and characteristics of CD collected at diagnosis, however their earliest LI was significantly increased. During follow-up 90 patients eventually required intestinal resection. Among 313 intervals between 2 evaluations, LI increased during 161 intervals (51%), remained unchanged during 59 intervals (19%), and decreased during 93 intervals (30%). In addition to intestinal resection, the percentage of time with clinically active disease was associated with increase of LI (p<0.001). Elevated CRP and treatment with immunomodulators or anti-TNF had no significant effect. However the increase of LI was mild in the 57 patients who received anti-TNF more than 80% of time (from 3.5 [1.6-7.2] to 4.1 [0.6-10.3]) and significantly reduced compared to those not on anti-TNF (n=204: from 2.9 [1.2-8.3] to 4.8 [1.0-10.8]) (p<0.01).

Conclusion

DD measured by LI increases significantly during the first years following diagnosis of CD. More than half the patients experience a substantial DD after 2-10 yr. Factors associated with DD are elevated LI at first evaluation, then duration of clinical activity and intestinal resection. These results underline the importance of achieving prolonged clinical remission for preventing DD.