P312 Evolution of the Lemann index in Crohn's disease: a retrospective study
N. Duveau*1, M. Azahaf1, H. Panchal2, M. Nachury1, J.F. Colombel2, B. Pariente1
1CHU de Lille, Department of Gastroenterology, Lille, France, 2Icahn School of Medicine at Mount Sinai Hospital, Gastroenterology, New York, NY, United States
The development and the first validation of the Lemann index (LI), the first global Crohn's disease (CD) damage index assessing cumulative structural bowel damage in CD, has recently be published. The aim of the present study was to assess the evolution of the LI over time.
We conducted a retrospective observational study. All the patients underwent two digestive damage evaluations (E1 and E2), at two different times separated for at least 12 months. At each evaluation (E1 and E2), examinations were performed according to the investigational protocol of the LI, including clinical evaluation abdominal-magnetic resonance imaging (MRI) for all patients. Further investigations were based on the disease location: upper endoscopy for upper digestive tract, colonoscopy for colorectal disease, and pelvic-MRI for perianal disease. As defined in the protocol, all examinations were performed within a delay less than 4 months, at each evaluation.
Thirty CD patients were included. Among them, 2/30 (6.6 %), 29/30 (96.6%), 5/30 (16.6%), and 2/30 (6.6%) patients had upper digestive tract, small bowel, colonic, and anal CD respectively. At E1, median disease duration was 7 years (range: 0 - 25), 10/30 (33.3%) and 1/30 (3.3%) patients had underwent small bowel and colonic surgical resections respectively, and 10/30 patients (33.3%) and 18/30 patients (60.0%) had received immunosuppressive and anti-TNF therapies respectively. At E1, median LI was 2.5 (range: 0.0-29.0). Median time between E1 and E2 was 23 months (range: 13-56 months). Between E1 and E2, three patients had surgery (two intestinal resections and one colectomy), immunosuppressive therapy was introduced in two patients and anti-TNF therapy in 6 patients. At E2, median LI was 2.5 (range: 0.0-29.2). An increase of LI was observed in 11/30 patients (36.0%) and a decrease in 5/30 patients (16.0%). LI did not change in 14 (46.7%) patients. Median time between E1 and E2 was significantly longer in patients with an increase of LI compared to patients with no change of LI (30.0 and 19.5 months respectively, p < 0.05).
In this retrospective study, LI increased in more than one third of the patients. Importantly, increase of the LI was significantly related to disease duration, suggesting that digestive damage evaluations should not be performed within short delays.