Changes in the Lémann Index Values During the First Years of Crohn’s Disease

Background & Aims Stricturing or penetrating lesions develop over time in most patients with Crohn's disease. The Lemann Index indicates the degree of digestive damage at a given time in an individual. We tracked changes in Lemann Index scores in an inception cohort of patients and looked for factors associated with digestive damage. Methods We studied 221 patients diagnosed with Crohn's disease from 2004 through 2011 who received 2 or 3 serial morphologic evaluations over a period of 2 to 10 years. We collected cross-sectional images and had them reviewed by a gastroenterologist and a radiologist; Lemann index scores were calculated. A value of 2 was chosen as the cut-off value for substantial transparietal damage. Factors associated with a score greater than 2 at the last evaluation and progression of index scores were identified using univariate analysis and logistic regression analyses. Results The median index Lemann Index scores were 2.3 (interquartile range [IQR], 1.2–3.9) at first evaluation, 3.5 (IQR, 1.2–8.6) at 2 to 5 years after diagnosis, and 8.3 (IQR, 1.2–12.1) at 5 to 10 years after diagnosis. Index scores increased significantly at each stage compared with initial or previous values ( P Conclusions Based on an analysis of patients with Crohn's disease using the Lemann Index, nearly two thirds had substantial mucosal damage 2 to 10 years after diagnosis. High Lemann index scores at the first evaluation, time, persistent clinical activity, and intestinal resection are associated with damage.