BACKGROUND & AIMS: The Lémann Index is a tool measuring cumulative structural bowel damage in Crohn's disease (CD). We reported on its validation and updating. METHODS: This was an international, multicenter, prospective, cross-sectional observational study. At each center, 10 inclusions, stratified by CD duration and location, were planned. For each patient, the digestive tract was divided into 4 organs, upper tract, small bowel, colon/rectum, anus, and subsequently into segments, explored systematically by magnetic resonance imaging and by endoscopies in relation to disease location. For each segment, investigators retrieved information on previous surgical procedures, identified predefined strictures and penetrating lesions of maximal severity (grades 1-3) at each organ investigational method (gastroenterologist and radiologist for magnetic resonance imaging), provided segmental damage evaluation ranging from 0.0 to 10.0 (complete resection). Organ resection-free cumulative damage evaluation was then calculated from the sum of segmental damages. Then investigators provided a 0-10 global damage evaluation from the 4-organ standardized cumulative damage evaluations. Simple linear regressions of investigator damage evaluations on their corresponding Lémann Index were studied, as well as calibration plots. Finally, updated Lémann Index was derived through multiple linear mixed models applied to combined development and validation samples. RESULTS: In 15 centers, 134 patients were included. Correlation coefficients between investigator damage evaluations and Lémann Indexes were >0.80. When analyzing data in 272 patients from both samples and 27 centers, the unbiased correlation estimates were 0.89, 0,97, 0,94, 0.81, and 0.91 for the 4 organs and globally, and stable when applied to one sample or the other. CONCLUSIONS: The updated Lémann Index is a well-established index to assess cumulative bowel damage in CD that can be used in epidemiological studies and disease modification trials.

American Gastroenterology Center Cyprus

Department of Gastroenterology Hepatology and Nutrition University Hospital Centre Zagreb Zagreb Croatia

Department of Gastroenterology Medical Division Hvidovre University Hospital Hvidovre Denmark

Department of Gastroenterology North Zealand University Hospital Capital Region Denmark

Department of Gastroenterology Slagelse Hospital Slagelse Denmark

Department of Gastroenterology University of Medicine Timișoara România

Department of Inflammatory Bowel Disease St Mark's Hospital and Imperial College London London United Kingdom

Department of Medicine Division of Gastroenterology Icahn School of Medicine at Mount Sinai New York New York

Department of Radiology Na Homolce Hospital Prague Czech Republic

Department of Radiology Tallaght University Hospital Dublin Ireland

Division of Gastroenterology Department of Internal Medicine Faculty of Medicine University of Ioannina School of Health Sciences Ioannina Greece

Division of Gastroenterology Department of Surgery Oncology and Gastroenterology University of Padova Padova Italy

Division of Gastroenterology Surgical Department Hospital Beatriz Ângelo Loures Portugal

Hepato Gastroenterology Department Claude Huriez Hospital University of Lille Lille France

Inflammatory Bowel Diseases Clinical and Research Center ISCARE a s Prague Czech Republic; Institute of Pharmacology 1st Faculty of Medicine Charles University Prague Czech Republic

Inflammatory Bowel Diseases Unit Hull University Teaching Hospitals National Health Service Trust Hull United Kingdom

INSERM U1135 Centre de Recherche Epidémiologie et Statistiques Equipe Epidemiology and Clinical Statistics for Tumor Respiratory and Resuscitation Assessments Université de Paris Hôpital Saint Louis Paris France

Mater Dei Hospital Department of Medicine Division of Gastroenterology Msida Malta

Radiology Department Claude Huriez hospital University of Lille Lille France

Radiology Department St Mark's Hospital and Imperial College London United Kingdom

Radiology Unit University of Padova Padova Italy

TAGG Research Centre School of Medicine Trinity College Dublin Dublin Ireland

Gastroenterology. 2021 Sep;161(3):800-802. doi: 10.1053/j.gastro.2021.06.047. PubMed

Gastroenterology. 2021 Nov;161(5):1728-1730. doi: 10.1053/j.gastro.2021.09.039. PubMed

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