Development of the Lémann Index to Assess Digestive Tract Damage in Patients With Crohn's Disease

Pariente, Benjamin; Mary, Jean Yves; Danese, Silvio; Chowers, Yehuda; Cruz, Peter De; D’Haens, Geert R.; Loftus, Edward V.; Louis, Édouard; Panés, Julián; Schölmerich, Jürgen; Schreiber, Stefan; Vecchi, Maurizio; Branche, Julien; Bruining, David H.; Fiorino, Gionata; Herzog, Matthias; Kamm, Michael A.; Klein, Amir; Lewin, M.; Meunier, Paul; Ordás, I; Strauch, Ulrike; Tontini, Gian Eugenio; Zagdanski, A M; Bonifacio, Cristiana; Rimola, Jordi; Nachury, Maria; Leroy, C.; Sandborn, William J.; Colombel, Jean Fréd́eric; Cosnes, Jacques

doi:10.1053/j.gastro.2014.09.015

Cited by 275 publications

(170 citation statements)

References 17 publications

Supporting

Mentioning

163

Contrasting

Unclassified

Order By: Relevance

“…The measurement of disease duration starts from the time of diagnosis, but we know that the duration from the time symptoms begin to appear till a diagnosis of CD is made can be anywhere up to 5 years [31] and hence the actual duration of the disease may be underestimated. Bowel damage increases over time [32]. The behaviour of CD changes over time, evolving from an inflammatory disease behavior to stricturing and/or penetrating disease behaviour with a lower response to anti-TNFs and a need for surgery [33].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Mesalazine, Thiopurines and Tumour Necrosis Factor Antagonists in Preventing Post-Operative Crohn's Disease Recurrence in a Real-Life Setting

Allocca¹,

Landi

Bonovas³

et al. 2017

Digestion

Self Cite

View full text Add to dashboard Cite

Background: Most Crohn's disease (CD) patients develop endoscopic recurrence within one year of intestinal resection. The best treatment method to prevent post-operative CD recurrence remains uncertain. Methods: A total of 155 CD patients from 2 referral centres, who were undergoing intestinal resection with ileo-colonic anastomosis (January 2004-January 2015), were included. All subjects received preventive therapy with tumour necrosis factor antagonists (anti-TNFs), thiopurinesor mesalazine. The primary outcome was the rate of endoscopic recurrence (Rutgeerts score ≥i2) in the 3 treatment groups. Results: Patients treated with anti-TNFs were at significantly lower risk of endoscopic recurrence during the follow-up than those receiving thiopurines or mesalazine (incidence rates of 2.2, 3.0 and 4.8 per 100 person-months, respectively, log-rank, p = 0.011). The median time to recurrence was significantly longer in patients treated with anti-TNFs than in those who received thiopurines or mesalazine (37.0, 13.7, and 16.8 months, respectively, log-rank, p = 0.011). Anti-TNFs were more effective than mesalazine (univariable analysis, hazard ratio [HR] 0.45, 95% CI 0.26-0.77, p = 0.004; multivariable analysis, HR 0.45, 95% CI 0.26-0.77, p = 0.004), and non-significantly superior over thiopurines. Conclusion: Anti-TNF therapy was the most effective strategy for the prevention of endoscopic CD recurrence.

show abstract

Section: Discussionmentioning

confidence: 99%

Effectiveness of Mesalazine, Thiopurines and Tumour Necrosis Factor Antagonists in Preventing Post-Operative Crohn's Disease Recurrence in a Real-Life Setting

Allocca¹,

Landi

Bonovas³

et al. 2017

Digestion

Self Cite

View full text Add to dashboard Cite

show abstract

“…6,7 The Le´mann index represents an international effort to more comprehensively describe total bowel damage accounting for stricturing and penetrating disease using imaging. 8 However, obvious strictures represent late stage macroscopic events, when the window for medical intervention is nearing closure. Further, claims that bowel dilation is associated with the degree of intestinal fibrosis remain controversial.…”

Section: The Challenges Of Assessing Intestinal Fibrosismentioning

confidence: 99%

Imaging of intestinal fibrosis: current challenges and future methods

Stidham

Higgins

2016

United European Gastroenterology Journal

View full text Add to dashboard Cite

Crohn's disease (CD) activity assessments are dominated by inflammatory changes without discrete measurement of the coexisting fibrotic contribution to total bowel damage. Intestinal fibrosis impacts the development of severe structural complications and the overall natural history of CD. Measuring intestinal fibrosis is challenging and existing methods of disease assessment are unable to reliably distinguish fibrosis from inflammation. Both the immediate clinical need to measure fibrosis for therapeutic decision-making and the near-future need for tools to assess pipeline anti-fibrotic medications highlight the demand for biomarkers of fibrosis in CD. Developing non-invasive technologies exploit changes in intestinal perfusion, mechanical properties, and macromolecular content to provide quantitative markers of fibrosis. In this review of existing and experimental technologies for imaging intestinal fibrosis, we discuss the expanding capabilities of quantitative MR and ultrasound imaging, encouraging developments in non-invasive elastography, and emerging novel methods including photoacoustic imaging.

show abstract

“…CD tends to progress to more complicated disease phenotypes and outcomes as the structural damage to the bowel accumulates over time [1,2]. Current guidelines for the treatment of CD involving the ileum suggest the use of budesonide or glucocorticoids to induce remission [3].…”

Section: Introductionmentioning

confidence: 99%

Comparative Study of Two Cohorts of Newly Diagnosed Crohn's Disease Demonstrates Change in Therapeutic Strategies

Icht

Yanai²,

Ron³

et al. 2017

Digestion

View full text Add to dashboard Cite

Background: There has been a paradigm shift in the treatment of Crohn's disease (CD) involving the rapid introduction of biologics and/or immunomodulators after diagnosis. We wished to assess whether this was applied to patients with newly diagnosed CD in a tertiary inflammatory bowel disease referral centre in Israel. Methods: Newly diagnosed CD patients were stratified into 2 groups: the early group was diagnosed between 2005 and 2007 and the late group was diagnosed between 2010 and 2012. Baseline demographics, medical and surgical treatments, disease course and complications during those 2 periods were analyzed. Results: Each group included 60 patients. Significantly higher rates of immunomodulators and biologics were administered to patients in the late group compared to the early group (81.7 and 36.7% compared to 56.7 and 18.3%, p = 0.004 and p = 0.021, respectively). On the other hand, steroid therapy was less prevalent in the late (36.7%) group compared to that of the early group (56.7%), p = 0.059. Medical and surgical CD outcomes, including exacerbations/hospitalizations and surgeries, were comparable for both groups. Conclusions: There was a change in treatment strategy between 2005-2007 and 2010-2012, as reflected in higher proportions of biologics/immunomodulators for patients with newly diagnosed CD. This was associated with a steroid-sparing effect.

show abstract

Development of the Lémann Index to Assess Digestive Tract Damage in Patients With Crohn's Disease

Cited by 275 publications

References 17 publications

Effectiveness of Mesalazine, Thiopurines and Tumour Necrosis Factor Antagonists in Preventing Post-Operative Crohn's Disease Recurrence in a Real-Life Setting

Effectiveness of Mesalazine, Thiopurines and Tumour Necrosis Factor Antagonists in Preventing Post-Operative Crohn's Disease Recurrence in a Real-Life Setting

Imaging of intestinal fibrosis: current challenges and future methods

Comparative Study of Two Cohorts of Newly Diagnosed Crohn's Disease Demonstrates Change in Therapeutic Strategies

Contact Info

Product

Resources

About