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Validation and Update of the Lemann Index to Measure Cumulative Structural Bowel Damage in Crohn's Disease

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  • Benjamin Pariente
  • Joana Torres
  • Johan Burisch
  • Naila Arebi
  • Brigida Barberio
  • Dana Duricova
  • Pierre Ellul
  • Adrian Goldis
  • Ioannis Kaimakliotis
  • Konstantinos Katsanos
  • Željko Krznaric
  • Deirdre Mc Namara
  • Natalia Pedersen
  • Shaji Sebastian
  • Mustapha Azahaf
  • Petra Weimers
  • Philip Lung
  • Carmelo Lacognata
  • Martin Horak
  • Dimitrios Christodoulou
  • Viktor Domislovic
  • Ian Murphy
  • Jérôme Lambert
  • Ryan Ungaro
  • Jean-Frédéric Colombel
  • Jean-Yves Mary
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BACKGROUND & AIMS: The Lémann Index is a tool measuring cumulative structural bowel damage in Crohn's disease (CD). We reported on its validation and updating.

METHODS: This was an international, multicenter, prospective, cross-sectional observational study. At each center, 10 inclusions, stratified by CD duration and location, were planned. For each patient, the digestive tract was divided into 4 organs, upper tract, small bowel, colon/rectum, anus, and subsequently into segments, explored systematically by magnetic resonance imaging and by endoscopies in relation to disease location. For each segment, investigators retrieved information on previous surgical procedures, identified predefined strictures and penetrating lesions of maximal severity (grades 1-3) at each organ investigational method (gastroenterologist and radiologist for magnetic resonance imaging), provided segmental damage evaluation ranging from 0.0 to 10.0 (complete resection). Organ resection-free cumulative damage evaluation was then calculated from the sum of segmental damages. Then investigators provided a 0-10 global damage evaluation from the 4-organ standardized cumulative damage evaluations. Simple linear regressions of investigator damage evaluations on their corresponding Lémann Index were studied, as well as calibration plots. Finally, updated Lémann Index was derived through multiple linear mixed models applied to combined development and validation samples.

RESULTS: In 15 centers, 134 patients were included. Correlation coefficients between investigator damage evaluations and Lémann Indexes were >0.80. When analyzing data in 272 patients from both samples and 27 centers, the unbiased correlation estimates were 0.89, 0,97, 0,94, 0.81, and 0.91 for the 4 organs and globally, and stable when applied to one sample or the other.

CONCLUSIONS: The updated Lémann Index is a well-established index to assess cumulative bowel damage in CD that can be used in epidemiological studies and disease modification trials.

Original languageEnglish
Article number13
JournalGastroenterology
Volume161
Issue number3
Pages (from-to)853-864
Number of pages12
ISSN0016-5085
DOIs
Publication statusPublished - Sep 2021

    Research areas

  • Bowel Damage, Crohn's Disease, Lémann Index, Validation

ID: 65945086