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

J Crohns Colitis. 2015 Aug;9(8):633-9. doi: 10.1093/ecco-jcc/jjv080. Epub 2015 May 9.


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

Methods: 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.

Results: 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].

Conclusion: 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.

Keywords: Crohn’s disease; Lémann Index; anti-TNF; bowel damage; inflammatory bowel disease.

Publication types

  • Observational Study

MeSH terms

  • Adalimumab / therapeutic use*
  • Adolescent
  • Adult
  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Crohn Disease / drug therapy*
  • Crohn Disease / pathology
  • Drug Administration Schedule
  • Female
  • Follow-Up Studies
  • Humans
  • Infliximab / therapeutic use*
  • Injections, Intravenous
  • Kaplan-Meier Estimate
  • Logistic Models
  • Male
  • Middle Aged
  • Pilot Projects
  • Proportional Hazards Models
  • Prospective Studies
  • Sensitivity and Specificity
  • Severity of Illness Index*
  • Treatment Outcome
  • Young Adult


  • Anti-Inflammatory Agents, Non-Steroidal
  • Infliximab
  • Adalimumab