Bowel damage and disability in Crohn's disease: a prospective study in a tertiary referral centre of the Lemann Index and Inflammatory Bowel Disease Disability Index

Background The notion of Crohn's disease (CD) as a chronic, progressive and disabling condition has led to the development of new indexes: the Lemann Index measuring cumulative bowel damage and the Inflammatory Bowel Disease (IBD) Disability Index, assessing functional disability. Aims To measure the Lemann Index and the IBD Disability Index in a large prospective cohort of CD patients and to assess the correlation between these two indexes. Methods We performed a prospective study in a tertiary referral centre including all consecutive CD outpatients. We assessed the Lemann Index and the IBD Disability Index questionnaire in all patients. Results One hundred and thirty CD patients were consecutively included. The mean Lemann Index (+/- SD) was 11.9 +/- 14.1 and ranged from 0 to 72.5 points. Factors associated with a high bowel damage score were: disease duration, anal location, previous intestinal resection, clinical and biological disease activity, exposure to immunosuppressants, and exposure to anti-TNF (P < 0.005). Among patients exposed to anti-TNF, the Lemann Index was lower in those who were exposed in the first 2 years of their disease (P = 0.015). The mean IBD Disability Index was 28.8 +/- 6.3 and ranged from 0 to 71 points. The factors associated with high disability score were: female gender, anal location, extra digestive manifestations, clinical and biological disease activity and exposure to anti-TNF (P < 0.005). No correlation was observed between the Lemann Index and IBD Disability Index (P = 0.15). Conclusions This is the first study to prospectively evaluate the Lemann Index and the IBD Disability Index in a large cohort of CD patients in a tertiary centre. Early introduction of anti-TNF treatment was associated with lower bowel damage scores, and no correlation was observed between the Lemann Index and the IBD Disability Index. Further dedicated prospective studies are necessary to confirm these results.