Prospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2022; 10(33): 12208-12220
Published online Nov 26, 2022. doi: 10.12998/wjcc.v10.i33.12208
Predictors of bowel damage in the long-term progression of Crohn’s disease
Agnes Fernández-Clotet, Julian Panés, Elena Ricart, Jesús Castro-Poceiro, Maria Carme Masamunt, Sonia Rodríguez, Berta Caballol, Ingrid Ordás, Jordi Rimola
Agnes Fernández-Clotet, Julian Panés, Elena Ricart, Jesús Castro-Poceiro, Maria Carme Masamunt, Berta Caballol, Ingrid Ordás, Department of Gastroenterology, Hospital Clinic, Barcelona 08036, Spain
Agnes Fernández-Clotet, Julian Panés, Elena Ricart, Jesús Castro-Poceiro, Maria Carme Masamunt, Berta Caballol, Ingrid Ordás, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona 08036, Spain
Agnes Fernández-Clotet, Julian Panés, Elena Ricart, Jesús Castro-Poceiro, Maria Carme Masamunt, Berta Caballol, Ingrid Ordás, Jordi Rimola, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBEREHD, Madrid 28029, Spain
Sonia Rodríguez, Jordi Rimola, Department of Radiology, Hospital Clinic, Barcelona 08036, Spain
Author contributions: Fernández-Clotet A contributed to study design, study conduction, patient recruitment, data collection, data analysis, data interpretation, and drafting the article; Panés J, Ordás I, and Rimola J contributed to study design, patient recruitment, data collection, data interpretation, and drafting the article; Ricart E, Castro-Poceiro J, Masamunt MC, and Caballol B contributed to patient recruitment and data collection; Rodríguez S contributed to data collection; all authors critically reviewed the article and approved the final manuscript.
Supported by the Helmsley Charitable Trust Grant, No. 2015PG-IBD005.
Institutional review board statement: This study was evaluated and approved by the Local Ethics Committee (Approval No. HCB/2018/0160).
Clinical trial registration statement: This study is registered at the clinical hospital center “Hospital Clinic de Barcelona”. The registration identification number is HCB/2018/0160.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: Dr. Rimola reports grants from Abbvie, personal fees from Alimentiv, personal fees from Janssen, personal fees from Takeda, non-financial support from Gilead and from Agumab during the conduct of the study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jordi Rimola, MD, PhD, Consultant Physician-Scientist, Department of Radiology, Hospital Clinic, 170 Villarroel, Barcelona 08036, Spain. jrimola@clinic.cat
Received: September 14, 2022
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
Abstract
BACKGROUND

Crohn’s disease (CD) is a chronic inflammatory bowel disorder that progresses to bowel damage (BD) over time. An image-based index, the Lémann index (LI), has been developed to measure cumulative BD.

AIM

To characterize the long-term progression of BD in CD based on changes in the LI and to determine risk factors for long-term progression.

METHODS

This was a single-center longitudinal cohort study. Patients who had participated in prospective studies on the accuracy of magnetic resonance imaging using endoscopy as a gold standard and who had a follow-up of at least 5 years were re-evaluated after 5-12 years.

RESULTS

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 (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). No correlation was observed between BD progression and baseline clinical activity, biological markers, or severity of endoscopic lesions.

CONCLUSION

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 were ileal location, stricturing/fistulizing phenotype, and disease duration.

Keywords: Crohn’s disease, Lémann index, Bowel damage, Inflammatory bowel disease, Magnetic resonance imaging

Core Tip: The aim of the study was to characterize the long-term progression of bowel damage (BD) in patients with Crohn’s disease based on changes in the Lémann index. Predictors of BD progression were a baseline stricturing and fistulizing Crohn’s disease phenotype, ileal location, disease duration of more than 10 years, and a higher Lémann index stricturing score. Strict monitoring of BD-associated lesions during treatment, especially in those patients with a higher baseline Lémann index score, may help clinicians to improve treatment strategies in order to halt BD progression, adapting treatment based on risk factors identified in this study.