title: Changes in the Lémann Index Values During the First Years of Crohn's Disease.
abstract: OBJECTIVE
  Stricturing or penetrating lesions develop over time in most patients with Crohn's disease. The Lémann Index indicates the degree of digestive damage at a given time in an individual. We tracked changes in Lémann Index scores in an inception cohort of patients and looked for factors associated with digestive damage.
  
  
  METHODS
  We studied 221 patients diagnosed with Crohn's disease from 2004 through 2011 who received 2 or 3 serial morphologic evaluations over a period of 2 to 10 years. We collected cross-sectional images and had them reviewed by a gastroenterologist and a radiologist; Lémann index scores were calculated. A value of 2 was chosen as the cut-off value for substantial transparietal damage. Factors associated with a score greater than 2 at the last evaluation and progression of index scores were identified using univariate analysis and logistic regression analyses.
  
  
  RESULTS
  The median index Lémann Index scores were 2.3 (interquartile range [IQR], 1.2-3.9) at first evaluation, 3.5 (IQR, 1.2-8.6) at 2 to 5 years after diagnosis, and 8.3 (IQR, 1.2-12.1) at 5 to 10 years after diagnosis. Index scores increased significantly at each stage compared with initial or previous values (P < .0001). After 73 months (IQR, 51-96 mo) of follow-up evaluation, 138 patients had a Lémann Index score greater than 2.0. The only early factor that predicted later damage was the first index value. Intestinal resection, time, and the percentage of time elapsed with a clinically active disease were associated with progressing damage.
  
  
  CONCLUSIONS
  Based on an analysis of patients with Crohn's disease using the Lémann Index, nearly two thirds had substantial mucosal damage 2 to 10 years after diagnosis. High Lémann index scores at the first evaluation, time, persistent clinical activity, and intestinal resection are associated with damage.
authors.affiliation: Department of Gastroenterology, Centre Hospitalo-Universitaire de Caen, France.
authors.forename: Cyrielle
authors.initials: C
authors.lastname: Gilletta
authors.affiliation: Department of Radiology, Paul-Brousse Hospital, Villejuif, France.
authors.forename: Maïté
authors.initials: M
authors.lastname: Lewin
authors.affiliation: Department of Gastroenterology, Saint Antoine Hospital, Paris, France; Department of Gastroenterology, Saint Antoine Hospital, Assistance Publique Hôpitaux de Paris and Paris VI University, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Bourrier
authors.affiliation: Department of Gastroenterology, Saint Antoine Hospital, Paris, France; Department of Gastroenterology, Saint Antoine Hospital, Assistance Publique Hôpitaux de Paris and Paris VI University, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Nion-Larmurier
authors.affiliation: Department of Gastroenterology, Saint Antoine Hospital, Paris, France; Department of Gastroenterology, Saint Antoine Hospital, Assistance Publique Hôpitaux de Paris and Paris VI University, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Rajca
authors.affiliation: Department of Gastroenterology, Saint Antoine Hospital, Paris, France; Department of Gastroenterology, Saint Antoine Hospital, Assistance Publique Hôpitaux de Paris and Paris VI University, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Beaugerie
authors.affiliation: Department of Gastroenterology, Saint Antoine Hospital, Paris, France; Department of Gastroenterology, Saint Antoine Hospital, Assistance Publique Hôpitaux de Paris and Paris VI University, Paris, France.
authors.forename: Harry
authors.initials: H
authors.lastname: Sokol
authors.affiliation: Department of Gastroenterology, Centre Hospitalo-Universitaire de Lille, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Pariente
authors.affiliation: Department of Gastroenterology, Saint Antoine Hospital, Paris, France; Department of Gastroenterology, Saint Antoine Hospital, Assistance Publique Hôpitaux de Paris and Paris VI University, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Seksik
authors.affiliation: Department of Gastroenterology, Saint Antoine Hospital, Paris, France; Department of Gastroenterology, Saint Antoine Hospital, Assistance Publique Hôpitaux de Paris and Paris VI University, Paris, France. Electronic address: jacques.cosnes@sat.aphp.fr.
authors.forename: Jacques
authors.initials: J
authors.lastname: Cosnes
mesh_terms: D000328:Adult; D003424:Crohn Disease / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008137:Longitudinal Studies; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
keywords: Computed Tomography; Inflammatory Bowel Disease; Magnetic Resonance Imaging; Surgery