title: Structural bowel damage in quiescent Crohn's disease.
abstract: BACKGROUND
  Crohn's disease is associated with accumulation of progressive structural bowel damage (SBD) leading to the development of stenotic and penetrating complications. The data pertaining to the course of progression of SBD is scarce. The Lemann index (LI) is a novel tool for evaluation of SBD that incorporates pan-enteric clinical, endoscopic and imaging data.
  
  
  OBJECTIVE
  To evaluate the progression of SBD in quiescent CD patients.
  
  
  METHODS
  Patients with known quiescent small bowel Crohn's disease (CD) for at least 3 months (CDAI<220) were prospectively recruited and underwent repeated magnetic resonance enterographies (MRE) and video capsule endoscopies (VCE). Patients were assessed for SBD on initial and follow-up evaluation using relevant clinicopathological data, MRE and VCE results. Significant structural bowel damage (SBD) was identified as LI>4.8, and progression of SBD as LI>0.3.
  
  
  RESULTS
  Sixty one patients were enrolled in the study. Significant SBD was detected 13 (21.4%) on enrollment. Duration of disease (p=0.036) and history of CD-related surgery (p=0.0001) were associated with significant BD. Forty one patients underwent a follow-up MRE (14.8±2.5 months apart). LI was similar at baseline and follow-up. There was a negligible change in LI between the evaluations.
  
  
  CONCLUSIONS
  In patients with quiescent Crohn's disease, structural bowel damage was stable over a median of 14 months follow-up.
authors.affiliation: Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Marianne M
authors.initials: MM
authors.lastname: Amitai
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Moran
authors.initials: M
authors.lastname: Zarchin
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Adi
authors.initials: A
authors.lastname: Lahat
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Doron
authors.initials: D
authors.lastname: Yablecovitch
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Sandra
authors.initials: S
authors.lastname: Neuman
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Nina
authors.initials: N
authors.lastname: Levhar
authors.affiliation: Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Eyal
authors.initials: E
authors.lastname: Klang
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Avidan
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Shomron
authors.initials: S
authors.lastname: Ben-Horin
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Rami
authors.initials: R
authors.lastname: Eliakim
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel. Electronic address: ukopylov@gmail.com.
authors.forename: Uri
authors.initials: U
authors.lastname: Kopylov
mesh_terms: D000293:Adolescent; D000328:Adult; D053704:Capsule Endoscopy; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000473:pathology; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007421:Intestine, Small / Q000000981:diagnostic imaging* / Q000473:pathology; D007557:Israel; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Capsule endoscopy; Crohn's disease; Lemann index; Magnetic resonance enterography; Structural damage