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P142. Sensitivity of Lennard-Jones criteria in the diagnosis of Crohn's disease

S. Reinisch1,2, K. Schweiger3, B. Collet-Fenetrier4, L. Peyrin-Biroulet4, J. Panés5, W. Reinisch2,6, 1McMaster University, Internal Medicine, Hamilton, Canada, 2Medical University of Vienna, Internal Medicine, Vienna, Austria, 3Wilhelminenspital, Internal Medicine, Vienna, Austria, 4University and Hospital, Gastroenterology, Nancy, France, 5Hospital Clinic Barcelona, Gastroenterology Service, Barcelona, Spain, 6McMaster University, Internal Medicine, Hamilton, Canada

Background

Rapid and correct diagnosis of Crohn's disease (CD) is important to enable early treatment of this progressive disease, however a gold standard is not available. Lennard-Jones et al. defined macroscopic and histological criteria which are widely adopted for diagnosis of CD.

Aim: To determine the sensitivity and specificity of the Lennard-Jones criteria for the diagnosis of CD.

Methods

Included were patients from 3 tertiary centres (Nancy, Barcelona and Vienna) managed as long-standing CD whose records from up to 6 months after initial diagnosis were reviewed. Cases were then re-classified according to Lennard-Jones criteria. CD was rated as “established” (granuloma + one minor criterion or 3 minor criteria, which include macroscopic discontinuity, transmural inflammation, fibrosis, lymphoid aggregates or discontinuous inflammation on histology), “probable” (2 minor criteria without granulomas) or “non CD”. Sensitivity and specificity were calculated including patients with ulcerative colitis (UC) as controls.

Results

Overall, 334 patients with CD and 170 patients with UC were assessed. At time of diagnosis nearly half of all patients were diagnosed as “non CD” (see Table 1).

Sensitivity of Lennard-Jones criteria varied from 0.21 to 0.66 dependent upon centre and the stringency of defining CD (i.e. defining CD as established plus probable versus established CD only). Pooling patients from all centres resulted in a maximum sensitivity of 0.50 when combining “established CD” and “probable CD” for the diagnosis of CD.

Table 1. Diagnosis of CD according to Lennard-Jones criteria
Established CD, n (%)Sensi/Speci aProbable CD, n (%)Sensi/Speci bNon CD, n (%)
Barcelona49/101 (48.5%)0.49/1.0018/101 (17.8%)0.66/0.9834/101 (33.7%)
Nancy21/100 (21%)0.21/1.0021/100 (21%)0.42/0.9058/100 (58%)
Vienna42/133 (32%)0.32/0.9915/133 (11%)0.43/0.9776/133 (57%)
a Sensitivity and specificity of “established” CD at diagnosis of CD.
b Sensitivity and specificity of “established” plus “probable” CD at diagnosis of CD.

Conclusion

In nearly half of patients managed as long-standing CD at 3 referral centres the Lennard–Jones criteria would not provide the diagnosis of CD from initial examinations. Our data suggest that these criteria are not sensitive enough to allow a rapid diagnosis. Thus, there is dire need for prospectively validated diagnostic criteria of early CD.