title: Prevalence of Bowel Damage Assessed by Cross-Sectional Imaging in Early Crohn's Disease and its Impact on Disease Outcome.
abstract: OBJECTIVE
  Bowel damage in Crohn's disease [CD] is defined as the presence of intestinal strictures, fistulas or abscesses. Early disease may represent a window of opportunity for timely intervention. We evaluated disease activity and severity by the Lémann Index [LI] and the Magnetic Resonance Index of Activity [MaRIA] score, and their prognostic value in early CD.
  
  
  METHODS
  All consecutive patients diagnosed with CD in two referral centres, assessed by magnetic resonance imaging or computerized tomography, were prospectively included. Disease activity and bowel damage in early CD, the correlation between the LI and the MaRIA score, and the value of cross-sectional imaging findings in predicting disease progression were assessed. Statistical analyses employed time-to-event methods.
  
  
  RESULTS
  We included 142 consecutive CD patients. Median time from diagnosis to baseline imaging was 0.3 years; median follow-up time was 4.9 years. At diagnosis, 39.4% of CD patients had bowel damage. At multivariable analysis, bowel damage and the LI were independent prognostic factors for intestinal surgery (hazards ratio [HR]: 3.21 and 1.11, respectively, p<0.001), and of CD-related hospitalization during patient follow-up [HR: 1.88, p=0.002, and 1.08, p<0.001, respectively]. Disease activity as expressed by the MaRIA score did not predict the disease course. The correlation between the LI and MaRIA score was weak [rho: +0.32; p<0.001].
  
  
  CONCLUSIONS
  Four out of ten CD patients have bowel damage at the time of the first imaging study. The presence of bowel damage, and not the MaRIA score, in early CD is associated with a worse outcome, with increased risks of surgery and hospitalization.
authors: IBD Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy.
authors: Gionata
authors: G
authors: Fiorino
authors: Department of Hepato-Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France.
authors: Mathilde
authors: M
authors: Morin
authors: IBD Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy.
authors: Stefanos
authors: S
authors: Bonovas
authors: Radiology Unit, Humanitas Research Hospital, Humanitas Research Hospital, Rozzano, Milan, Italy.
authors: Cristiana
authors: C
authors: Bonifacio
authors: Colon and Rectal Surgery Unit, Department of Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.|Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.
authors: Antonino
authors: A
authors: Spinelli
authors: Department of Digestive Surgery, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France.
authors: Adeline
authors: A
authors: Germain
authors: Department of Radiology, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France.
authors: Valérie
authors: V
authors: Laurent
authors: Department of Hepato-Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France.
authors: Camille
authors: C
authors: Zallot
authors: Department of Hepato-Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France.
authors: Laurent
authors: L
authors: Peyrin-Biroulet
authors: IBD Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan, Italy.|Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.
authors: Silvio
authors: S
authors: Danese
mesh_terms: D018784:Abdominal Abscess / Q000000981:diagnostic imaging* / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology; D003424:Crohn Disease / Q000150:complications* / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000601:surgery; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007412:Intestinal Fistula / Q000000981:diagnostic imaging* / Q000209:etiology; D007422:Intestines / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D055815:Young Adult
chemical_list: D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha
keywords: Bowel damage; Lémann Index; complications; early Crohn’s disease