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Review
. 2016 Apr;10(4):495-500.
doi: 10.1093/ecco-jcc/jjv240. Epub 2016 Jan 7.

Preventing Collateral Damage in Crohn's Disease: The Lémann Index

Gionata Fiorino  1 , Cristiana Bonifacio  2 , Laurent Peyrin-Biroulet  3 , Silvio Danese  4
Affiliations
Review

Preventing Collateral Damage in Crohn's Disease: The Lémann Index

Gionata Fiorino et al. J Crohns Colitis. 2016 Apr.

Abstract

Crohn's disease [CD] is a chronic progressive and destructive condition. Half of all CD patients will develop bowel damage at 10 years. As in rheumatic diseases, preventing the organ damage consequent to CD complications [fistula, abscess, and/or stricture] is emerging as a new therapeutic goal for these patients in clinical practice. This might be the only way to alter disease course, as surgery is often required for disease complications. Similar to the joint damage in rheumatoid arthritis, bowel damage has also emerged as a new endpoint in disease-modification trials such as the REACT trial. Recently, the Lemann Index [LI] has been developed to measure CD-related bowel damage, and to assess damage progression over time, in order to evaluate the impact of therapeutic strategies in terms of preventing bowel damage. While validation is pending, recent reports suggested that bowel damage is reversible by anti-tumour necrosis factor [TNF] therapy. The Lémann index may play a key role in CD management, and should be implemented in all upcoming disease-modification trials in CD.

Keywords: Crohn’s disease; Lémann index; bowel damage; imaging; inflammatory bowel disease.

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Figures

Figure 1.
Figure 1.
Changes in the Lémann Index over time compared with activity indexes for Crohn’s disease [CD] (clinical, endoscopic, and magnetic resonance imaging [MRI]-based scores). Independently from disease activity, the ‘residual’ damage after a disease flare remains stable over time and increases after surgery.
Figure 2.
Figure 2.
Evolution of bowel damage over time assessed by magnetic resonance imaging [MRI] in a male patient with 20-cm long stricturing ileal Crohn’s disease at diagnosis. a, between arrows, Lémann Index 0.6, then developed a fistula between ileum and rectum. b, within the circle, Lémann Index 1.6, underwent surgical resection [Lémann Index 8.3 after surgery], and had further anastomotic recurrence. c, within surgery, Lémann Index 9.0. The Lémann Index was able to assess the severity of damage and its progression over time.
See this image and copyright information in PMC

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