Calculation of the Lémann index at initial Presentation of Crohn’s disease in a sample of Iraqi patients attending gastroenterology and hepatology teaching hospital

Main Article Content

Askkar Basim A.
Nawres Hatif Jassam
Hasan Osamah Al-Obaidi



Introduction : Crohn’s disease(CD) is a chronic inflammatory disorder that may involve any part of the alimentary tract from mouth to anus and is characterized by periods of clinical remission alternating with periods of recurrence. Current clinical and endoscopic indices only measure disease activity at a specific time point . The recently published  Lémann  index(LI) is the first tool that aims to measure cumulative structural bowel damage and thus evaluates long-term disability .

Aim of study : To measure the LI at initial presentation of CD in a sample of Iraqi patients attending the gastroenterology and hepatology teaching hospital (Baghdad).

Patients and methods : This is a descriptive single center study conducted in gastroenterology and hepatology teaching hospital and enrolled 30 patients with CD diagnosed from 2013 through 2015 . They all underwent complete physical examination , abdominopelvic CT scan , upper endoscopy and colonoscopy upon diagnosis for the purpose of assessing bowel damage by the  LI .

Results :  For the thirty patients included , median  LI  was 1.3   ( range 0.2- 12.6 ).

Conclusion :  The LI is now available and it enables, for the first time, assessment of bowel damage in CD.

Key Words: Colonoscopy;Terminal Ilum; Crohns Disease; Lémann index

Abstract 215 | PDF Downloads 100 XML Downloads 165 HTML Downloads 108


1- Sands,Bruce E. and Siegel Corey A. Crohn’s Disease in Sleisenger and Fordtran’s Gastrointestinal and liver disease. 10th. Edition . Philadelphia : Elsevier Saunders.2016.PP.1990,1998.
2- FarmerRG, HawkWA, TurnbullRBJr. Clinical patterns in Crohn's disease: a statistical study of 615 cases. Gastroenterology1975;68:627.
3- WagtmansMJ, VerspagetHW, LamersCB, et al.Clinical aspects of Crohn's disease of the upper gastrointestinal tract: a comparison with distal Crohn's disease. Am J Gastroenterol1997;92:1467.
4- Melmed, Gil Y. and Targan Stephan R. Crhon’s disease : clinical manifestations and management in Yamada’s Textbook of Gastroenterology. 6th. Edition. Chichester: John Wiley & Sons Ltd. 2016.P. 1421.
5- Louis E., Collard A., Orger AF, et al. Behavior of Crohn’s disease according to the Vienna classification: changing pattern over the course of the disease. Gut 2001; 49:777-782.
6- Cosnes J. , Cattan S. , Blain A. et al. Long-term evolution of disease behavior of Crohn’s disease. Inflamm Bowel Dis2002;8:244-250.
7- Thia KT, Sandborn WJ, Harmsen WS, et al. Risk factors associated with progression to intestinal complications of Crohn’s disease in a population-based cohort. Gastroenterology 2010;139:1147-1155.
8- Peyrin-Biroulet L., Loftus EV Jr. Colombel JF, et al. The natural history of adult Crohn’s disease in population-based cohorts. Am J Gastroenterol 2010; 105:289-297.
9- Colombel, Jean-Frederic, Louis E., Peyrin-Biroulet L. et al. “ Deep Remission: A New Concept?” Dig Dis 2012;30(suppl 3):107–111.
10- D’ Inca’, Renata and Caccaro,Roberta. Measuring disease activity in Crohn’s disease: What is currently available to the clinician. Clin Exp Gastroenterol.2014;7:151-161.
11- Rutgeerts P, Van Assche G, Sandborn WJ, et al.Adalimumab induces and maintains mucosal healing in patients with Crohn's disease: data from the EXTEND trial. Gastroenterology2012;142:1102.
12- Louis E, Mary JY, Vernier?Massouille G, et al.Maintenance of remission among patients with Crohn's disease on antimetabolite therapy after infliximab therapy is stopped. Gastroenterology2012;142:63, e31.
13- Mathy C, Schneider K, Chen YY, et al.Gross versus microscopic pancolitis and the occurrence of neoplasia in ulcerative colitis. Inflamm Bowel Dis2003;9:351.
14- Pariente B., Cosnes J, Danese S, et al.Development of the Crohn's disease digestive damage score, the Lemann score. Inflamm Bowel Dis2011;17:1415.
15- Pariente B. , Mary JY, Danese S , Chowers Y. , De Cruz P. , D’ Haens G,.et al. Development of the lemann index to assess digestive tract damage in patients with Crohn’s disease. Gastroenterology, 2015; 148, 52-63.e 3.
16- Allen PB, Peyrin- Biroulet L. Moring towards disease modification in inflammatory bowel disease therapy . Curr Opin Gastroenterol. 2013; 29: 397-404.
17- Ghosh, S .Pariente , B. Mould, D.R. et al. New tools and approaches for improved management of inflammatory bowel diseases.Journal of European Crohn’s and Colitis Organization (2014) 8, 1246-1253.
18- Gilletta C , Lewin M , Bourrier A. et al. Changes in the Lemann Index Values during the First Years of Crohn’s Disease .Clin GastroenterolHepatol.2015. .
19- Peyrin-Biroulet L., Loftus EV Jr., Colombel JF, et al. Early Crohn disease : a proposes definition for use in disease–modification trials. Gut.2010;59:141-147.
20- Ananthakrishnan, Ashwin N. and Hanauer Stephen B. The Holy Grail, or Only Half Way There? . Gastrojournal .org 2015.Vol. 148, issue 1 , p. 8-10.
21- G. Bodini , V. Savarino , I. Baldissarro , C. De Maria , et al. Biological Therapy Is Able To Modify The Disease Progression of Crohn's Disease Preventing Its Long-Term Associated Disability - A Study Performed By Using The Lèmann Score.2015. European Crohn’s and Colitis Organization.
22- G. Fiorino, M. Allocca, C. Bonifacio, P. Naccarato, et al. Lémann Index assessment over time in Crohn's disease patients treated with anti TNFs: a pilot observational cohort study. 2014. . European Crohn’s and Colitis Organization.
23- Fiorino G, Bonifacio C, Peyrin-Biroulet L, et al. Preventing Collateral Damage in Crohn's Disease: The Lémann Index.2016. European Crohn’s and Colitis Organization.