Bowel Damage as Assessed by the Lémann Index is Reversible on Anti-TNF Therapy for Crohn's Disease

Bowel damage [BD] will develop in the majority of Crohn's disease [CD] patients. Recently, the Lémann Index [LI] was developed to measure BD.

This was a prospective single-center cohort study. All included patients underwent full evaluation for bowel damage before starting anti-TNF therapy and every year thereafter. BD at baseline and during follow-up was measured using the LI. We assessed the impact of anti-TNF therapy on BD. We also assessed the sensitivity to change of the LI and the relationship between BD progression and disease outcomes, including the need for surgery.

Thirty CD patients were enrolled [13 on infliximab, 17 on adalimumab]. Median baseline LI was 9.1 [range, 1.6-34.1]. Median follow up was 32.5 months [range, 10-64].By a ROC curve analysis, a LI >4.8 defined CD subjects with BD. Any change >0.3 in the LI was related to BD change [AUC 0.98]. During follow-up, 83% of subjects had BD regression and 17% had BD progression. Anti-TNF therapy significantly reduced LI at 12 months [p=0.007]. Subjects with BD progression were more likely to undergo major abdominal surgery through the follow-up period [HR 0.19, p=0.005].

The LI has good sensitivity to change. Anti-TNFs agents are able to reverse BD in some CD patients. BD progression as measured by the LI may be predictive of major abdominal surgery in these patients.