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P117 Can we identify risk factors for the progression of bowel damage in Crohn’s disease using the Lémann index?

M. Zarchin1,2, H. Haskiya1, F. Sklerovesy Benjaminov1,2, A. Stein1, Y. Ringel1, T. Naftali*1,2

1Meir Hospital, Gastroenterology and Liver disease, Kfar Saba, Israel, 2Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel

Background

Prediction of disease course in Crohn’s disease is inaccurate, resulting in either over or under treatment. The Lemann index (LI) evaluates extent of structural bowel damage (SBD) based on clinical, endoscopic and imaging data from computerised tomography or magnetic resonance imaging. We aimed to identify demographic and disease parameters that are associated with worsening of LI

Methods

This is a comparative retrospective study of adult patients diagnosed with Crohn’s disease at Meir Medical Center between 2004 and 2016. Patients were included if they had two imaging studies (CT or MRI) at least 1 year apart. Imaging were evaluated by an experienced radiologist for degree of bowel damage using the LI. Significant SBD was defined as LI score >4.8. SBD progression was identified as Delta LI(DLI)>0.3. Variables of interest included gender, age at diagnosis, disease duration and location, smoking, surgical history, family history of IBD and treatment.

Results

Sixty patients were recruited. Significant SBD was detected in 13 (21.7%) on the first LI evaluation. Disease location (colonic and perianal, p = 0.015, p = 0.008,, respectively) and previous surgeries (bowel resection and perianal surgery, p = 0.006, p = 0.009, respectively) were associated with significant SBD. Disease duration and smoking were not associated with significant SBD. Significant progression of SBD (DLI >0.3) was detected in 29 (48.3%) patients in an average time of 40.8 ± 23.8 months. DLI >0.3 was associated with history of bowel resection (p < 0.001) and time elapsed from one imaging to the next (p = 0.043). Both parameters are embedded in the LI scoring system. Other parameters including: initial LI score, smoking status and medical treatment (specifically with biologic agents) were not associated with significant SBD progression.

Abstract PO117

DLI < 0.3 (n = 31)DLI > 0.3 (n = 29)p-value
Disease duration, years2.8 ± 2.72.8 ± 3.10.841
Smoking (current and previous)9 (34.6%)6 (24.0%)0.406
Current treatmentNone9(29.0%)6(20.7%)0.456
Immunomodulators9 (29.0%)6 (20.7%)0.456
Immunomodulators + anti-TNFs8 (25.8%)8 (27.6%)0.876
Any biological13 (41.9%)17 (58.6%)0.196
first Lémann score3.9 ± 4.52.9 ± 2.60.278
Bowel resection (Betweenfirst and second Lémanns)0 (0.0%)12 (41.4%)<0.0001
Months between first and second Lémann35.2 ± 22.446.8 ± 24.10.043

Comparison of patients with and without significant progression of structural bowel damage as measured by delta Lemann index (DLI).

Data of SBD progression are summarised in Table 1.

Conclusion

Perianal disease predicted intestinal structural damage as reflected by a higher initial LI. Involvement of the distal gastrointestinal system (colonic and perianal) was associated with an initially higher LI, reflecting more sever SBD. Smoking, medical treatment or initial LI did not predict progression of LI. Despite the long time difference between the two imaging studies no parameters predicted the accumulation of SBD other than those embedded in the LI scoring system. A longer interval between the two studies was associated with further progression of LI. Surprisingly, medical treatment, and specifically biologic treatment, between the two studies did not prevent progression of LI.