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P232 Paediatric Crohn’s disease and its disability over time: a study performed with a new paediatric Lemann Index: preliminary data from a tertiary Paediatric IBD centre

G. Bodini*1, S. Arrigo2, A. Bizzocchi2, E. G. Giannini1, V. Savarino1, E. Savarino3, A. Barabino2

1University of Genoa, Internal Medicine Department, Genoa, Italy, 2G. Gaslini Institute, Paediatric Gastroenterology and Endoscopy, Genoa, Italy, 3University of Padua, Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, Padua, Italy

Background

Crohn’s disease (CD) is a chronic condition that leads to surgical resection in the majority of cases. A panel of experts developed the Lemann Index (LI), a new tool aimed to assess the progressive bowel damage because of disease course. The aim of LI is to assess bowel damage resulting from CD, based on stricturing lesions, penetrating lesions, and surgical resection. However, in the paediatric population, we should also take into account peculiar characteristics, such as intestinal length and the pattern of growth of the patient.

Methods

The aim of our study was to measure the LI in a paediatric cohort at diagnosis, as well as the trend over time. We chose segments of 10 cm for small bowel, instead of 20 cm as proposed in adults. We decided to adjust the final score considering growth failure, using different values based on weight and height at diagnosis and at the last evaluation. We called this score paediatric LI (P-LI). We retrospectively selected 47 consecutive paediatric patients who were first diagnosed at our hospital by abdominal magnetic resonance imaging, colonoscopy, and upper GI endoscopy, and in case of perianal disease, a pelvic MRI. Patients were aged between 6 to 17 years. We evaluated the P-LI at diagnosis and calculated the difference between P-LI at diagnosis and at the last paediatric outpatient visit or at transition to adult outpatient

Results

We included a total of 47 CD paediatric patients (23 male, median age 18 years, range 11–27, median age at diagnosis 12 years, range 7–17) who were followed-up for a median of 41 months (range 4–120). Amongst them, 30 (63.8%) patients had a stable P-LI during the follow-up, whereas 17 (36.2%) had an increase in P-LI during time. Considering the overall population there was no statistically significant difference between median P-LI at beginning and at the end of follow-up (4.6, range 0.6–15 vs 3, range 0.3–31.7, p = 0.064). Subdividing patients who underwent surgical resection (n = 12, 25.5%) and those who did not (n = 35, 74.5%) we found a significant difference between median P-LI at the beginning and at the end of follow-up in both groups (4.4, range 1–12.8 vs 15.3, range 8.3–31.7, p = 0.0002; 4.6, range 0.6–15 vs 1.6, range 0–18.5, p = 0.001) with a disease regression in the no surgery group. Moreover, analysing data from patients who utilised anti-TNF therapies (n = 22, 46.8%), we found no significant difference between LI at the beginning and at the end of follow-up (5, range 1–15 vs 4.2, range 0.6–12.8, p = 0.3).

Conclusion

Our data suggest that the P-LI we devised is a useful tool to evaluate CD in the paediatric population and to assess disease progression. In children, avoiding a surgical resection is extremely important because medical therapy is able to reverse the disease progression