Published online Nov 26, 2022. doi: 10.12998/wjcc.v10.i33.12208
Peer-review started: September 14, 2022
First decision: September 26, 2022
Revised: October 6, 2022
Accepted: October 31, 2022
Article in press: October 31, 2022
Published online: November 26, 2022
Crohn’s disease (CD) progresses to bowel damage (BD) over time. An image-based index, the Lémann index (LI), has been developed and validated to measure cumulative BD. The LI consists of a scoring system based on a comprehensive assessment of structural BD, which includes the identification of stricturing and penetrating lesions based on cross-sectional imaging and endoscopy, and previous surgery.
Risk factors for BD progression are not well identified. Studies that evaluate damage severity have a short period of observation, whereas damage accumulates over long periods of time.
To characterize the long-term progression of BD in patients with CD based on changes in the LI, to identify which components of the index are the main determinants of progression, and to identify risk factors for long-term progression.
We performed a longitudinal cohort study in the tertiary referral center Hospital Clinic of Barcelona from April 2018 to December 2019. We took advantage of our patient cohorts that had participated in past studies on the accuracy of magnetic resonance imaging for characterizing CD inflammatory activity using endoscopy as the gold standard. We invited patients that had undergone these examinations within the past 5 years to 12 years to be re-evaluated in the context of the current study. BD and its progression over time were assessed for each patient using the LI and calculated at baseline and at the second assessment.
Seventy-two patients were included. LI increased in 38 patients (52.8%), remained unchanged in 9 patients (12.5%), and decreased in 25 patients (34.7%). The small bowel score and surgery subscale significantly increased (P = 0.002 and P = 0.001, respectively), whereas the fistulizing subscale significantly decreased (P = 0.001). Baseline parameters associated with BD progression were ileal location (P = 0.026), CD phenotype (stricturing, fistulizing, or both with P = 0.007, P = 0.006, and P = 0.035, respectively), disease duration > 10 years (P = 0.019), and baseline LI stricturing score (P = 0.049).
BD, as assessed by the LI, progressed in half of the patients with CD over a period of 5-12 years. The main determinants of BD progression are ileal location, stricturing/fistulizing phenotype, and disease duration.
The timepoint to evaluate BD progression is still not yet established. Some treatment can prevent BD progression, but we still do not have robust data to confirm these findings.