Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Nov 26;10(33):12208-12220.
doi: 10.12998/wjcc.v10.i33.12208.

Predictors of bowel damage in the long-term progression of Crohn's disease

Agnes Fernández-Clotet  1   2   3 , Julian Panés  1   2   3 , Elena Ricart  1   2   3 , Jesús Castro-Poceiro  1   2   3 , Maria Carme Masamunt  1   2   3 , Sonia Rodríguez  4 , Berta Caballol  1   2   3 , Ingrid Ordás  1   2   3 , Jordi Rimola  3   5
Affiliations

Predictors of bowel damage in the long-term progression of Crohn's disease

Agnes Fernández-Clotet et al. World J Clin Cases. .

Abstract

Background: Crohn's disease (CD) is a chronic inflammatory bowel disorder that progresses to bowel damage (BD) over time. An image-based index, the Lémann index (LI), has been developed to measure cumulative BD.

Aim: To characterize the long-term progression of BD in CD based on changes in the LI and to determine risk factors for long-term progression.

Methods: This was a single-center longitudinal cohort study. Patients who had participated in prospective studies on the accuracy of magnetic resonance imaging using endoscopy as a gold standard and who had a follow-up of at least 5 years were re-evaluated after 5-12 years.

Results: Seventy-two patients were included. LI increased in 38 patients (52.8%), remained unchanged in 9 patients (12.5%), and decreased in 25 patients (34.7%). The small bowel score and surgery subscale significantly increased (P = 0.002 and P = 0.001, respectively), whereas the fistulizing subscale significantly decreased (P = 0.001). Baseline parameters associated with BD progression were ileal location (P = 0.026), CD phenotype [stricturing, fistulizing, or both (P = 0.007, P = 0.006, and P = 0.035, respectively)], disease duration > 10 years (P = 0.019), and baseline LI stricturing score (P = 0.049). No correlation was observed between BD progression and baseline clinical activity, biological markers, or severity of endoscopic lesions.

Conclusion: BD, as assessed by the LI, progressed in half of the patients with CD over a period of 5-12 years. The main determinants of BD progression were ileal location, stricturing/fistulizing phenotype, and disease duration.

Keywords: Bowel damage; Crohn’s disease; Inflammatory bowel disease; Lémann index; Magnetic resonance imaging.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: Dr. Rimola reports grants from Abbvie, personal fees from Alimentiv, personal fees from Janssen, personal fees from Takeda, non-financial support from Gilead and from Agumab during the conduct of the study.

Figures

Figure 1
Figure 1
Flow chart of patients included in the study.
Figure 2
Figure 2
Receiver operating characteristic curve for the prediction of bowel damage progression. The line with dots represents the receiver operating characteristic curve; the line without dots is the reference diagonal. ROC: Receiver operating characteristic.
See this image and copyright information in PMC

References

    1. Thia KT, Sandborn WJ, Harmsen WS, Zinsmeister AR, Loftus E V. Risk factors associated with progression to intestinal complications of Crohn’s disease in a population-based cohort. Gastroenterology. 2010 - PMC - PubMed
    1. Pariente B, Mary JY, Danese S, Chowers Y, De Cruz P, D’Haens G. Development of the Lémann index to assess digestive tract damage in patients with Crohn’s disease. Gastroenterology. 2015 - PubMed
    1. Pariente B, Torres J, Burisch J, Arebi N, Barberio B, Duricova D. Validation and Update of the Lémann Index to Measure Cumulative Structural Bowel Damage in Crohn’s Disease. Gastroenterology. 2021 - PMC - PubMed
    1. Van Assche G, Dignass A, Panes J, Beaugerie L, Karagiannis J, Allez M. The second European evidence-based Consensus on the diagnosis and management of Crohn’s disease: Definitions and diagnosis. J Crohn’s Colitis. 2010 - PubMed
    1. Lauriot dit Prevost C, Azahaf M, Nachury M, Branche J, Gerard R, Wils P. Bowel damage and disability in Crohn’s disease: a prospective study in a tertiary referral centre of the Lémann Index and Inflammatory Bowel Disease Disability Index. Aliment Pharmacol Ther. 2020 - PubMed