title: Bowel Damage as Assessed by the Lémann Index is Reversible on Anti-TNF Therapy for Crohn's Disease.
abstract: OBJECTIVE
  Bowel damage [BD] will develop in the majority of Crohn's disease [CD] patients. Recently, the Lémann Index [LI] was developed to measure BD.
  
  
  METHODS
  This was a prospective single-center cohort study. All included patients underwent full evaluation for bowel damage before starting anti-TNF therapy and every year thereafter. BD at baseline and during follow-up was measured using the LI. We assessed the impact of anti-TNF therapy on BD. We also assessed the sensitivity to change of the LI and the relationship between BD progression and disease outcomes, including the need for surgery.
  
  
  RESULTS
  Thirty CD patients were enrolled [13 on infliximab, 17 on adalimumab]. Median baseline LI was 9.1 [range, 1.6-34.1]. Median follow up was 32.5 months [range, 10-64].By a ROC curve analysis, a LI >4.8 defined CD subjects with BD. Any change >0.3 in the LI was related to BD change [AUC 0.98]. During follow-up, 83% of subjects had BD regression and 17% had BD progression. Anti-TNF therapy significantly reduced LI at 12 months [p=0.007]. Subjects with BD progression were more likely to undergo major abdominal surgery through the follow-up period [HR 0.19, p=0.005].
  
  
  CONCLUSIONS
  The LI has good sensitivity to change. Anti-TNFs agents are able to reverse BD in some CD patients. BD progression as measured by the LI may be predictive of major abdominal surgery in these patients.
authors.affiliation: Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy.
authors.forename: Gionata
authors.initials: G
authors.lastname: Fiorino
authors.affiliation: Radiology, Humanitas Research Hospital, Rozzano, Milan, Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Bonifacio
authors.affiliation: Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Allocca
authors.affiliation: Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Repici
authors.affiliation: Radiology, Humanitas Research Hospital, Rozzano, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Balzarini
authors.affiliation: Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy Translational Medicine, University of Milan, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Malesci
authors.affiliation: Department of Hepato-Gastroenterology, University Hospital of Nancy, Université de Lorraine, Vandoeuvre-lès-Nancy, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Peyrin-Biroulet
authors.affiliation: Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy sdanese@hotmail.com.
authors.forename: Silvio
authors.initials: S
authors.lastname: Danese
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D003424:Crohn Disease / Q000188:drug therapy* / Q000473:pathology; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab / Q000627:therapeutic use*; D007275:Injections, Intravenous; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000069285:Infliximab; D000068879:Adalimumab
keywords: Crohn’s disease; Lémann Index; anti-TNF; bowel damage; inflammatory bowel disease