Amitai Marianne M, Zarchin Moran, Lahat Adi, Yablecovitch Doron, Neuman Sandra, Levhar Nina, Klang Eyal, Avidan Benjamin, Ben-Horin Shomron, Eliakim Rami, Kopylov Uri
Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel.
Dig Liver Dis. 2017 May;49(5):490-494. doi: 10.1016/j.dld.2017.02.001. Epub 2017 Feb 13.
Crohn's disease is associated with accumulation of progressive structural bowel damage (SBD) leading to the development of stenotic and penetrating complications. The data pertaining to the course of progression of SBD is scarce. The Lemann index (LI) is a novel tool for evaluation of SBD that incorporates pan-enteric clinical, endoscopic and imaging data.
To evaluate the progression of SBD in quiescent CD patients.
Patients with known quiescent small bowel Crohn's disease (CD) for at least 3 months (CDAI<220) were prospectively recruited and underwent repeated magnetic resonance enterographies (MRE) and video capsule endoscopies (VCE). Patients were assessed for SBD on initial and follow-up evaluation using relevant clinicopathological data, MRE and VCE results. Significant structural bowel damage (SBD) was identified as LI>4.8, and progression of SBD as LI>0.3.
Sixty one patients were enrolled in the study. Significant SBD was detected 13 (21.4%) on enrollment. Duration of disease (p=0.036) and history of CD-related surgery (p=0.0001) were associated with significant BD. Forty one patients underwent a follow-up MRE (14.8±2.5 months apart). LI was similar at baseline and follow-up. There was a negligible change in LI between the evaluations.
In patients with quiescent Crohn's disease, structural bowel damage was stable over a median of 14 months follow-up.
克罗恩病与进行性肠道结构损伤（SBD）的积累有关，可导致狭窄和穿透性并发症的发生。关于SBD进展过程的数据很少。勒曼指数（LI）是一种评估SBD的新工具，它整合了全肠道的临床、内镜和影像学数据。
评估静止期克罗恩病患者SBD的进展情况。
前瞻性招募已知静止期小肠克罗恩病（CD）至少3个月（CDAI<220）的患者，并进行重复磁共振肠造影（MRE）和视频胶囊内镜检查（VCE）。使用相关临床病理数据、MRE和VCE结果，在初始评估和随访评估中对患者的SBD进行评估。显著的肠道结构损伤（SBD）被定义为LI>4.8，SBD的进展为LI>0.3。
61例患者纳入研究。入组时检测到13例（21.4%）有显著SBD。疾病持续时间（p=0.036）和克罗恩病相关手术史（p=0.0001）与显著的肠道损伤相关。41例患者接受了随访MRE（间隔14.8±2.5个月）。基线和随访时LI相似。两次评估之间LI的变化可忽略不计。
在静止期克罗恩病患者中，肠道结构损伤在中位14个月的随访期内保持稳定。
