Table 2.
Measures of structural bowel damage in clinical studies.
| Study | Study design | Study population | Measure of structural damage | Main outcomes | Main results |
|---|---|---|---|---|---|
| Gilletta et al.30 | Retrospective cohort analysis | 221 CD subjects up to 10 years FU | LI | LI cut-off for damage | A LI score >2.0 is associated with bowel damage A high LI score at baseline, chronically active disease and intestinal resection were associated to BD progression over time |
| Duveau et al.32 | Retrospective cohort analysis | 30 CD subjects | LI | LI evolution over time (median time 23 months) | 1/3 of subjects have BD progression over time |
| Fiorino et al.31 | Prospective cohort | 30 CD subjects starting anti-TNF (median FU 32.5 months) | LI | Efficacy of anti-TNF on BD progression | Anti-TNFs block BD in 83% of subjects BD progression is associated with a higher risk for surgery Cut-off for BD: 4.8 Cut off for BD progression: >0.3 |
| Bodini et al.34 | Retrospective cohort analysis | 88 CD subjects treated with anti-TNF, IMM, or 5-ASA median FU 26 months | LI | Efficacy of different therapies on LI reduction | Anti-TNFs were more effective than IMM and 5-ASA at stopping bowel damage (p = 0.004) |
| Fiorino et al.12 | Retrospective cohort analysis | 142 consecutive CD patients (Milan, Nancy) at the time of diagnosis | LI | Prevalence of bowel damage at CD diagnosis Prognostic value of the LI in the follow-up (median time 4.9 years) | LI and presence of bowel damage were associated with a higher risk of surgery (HR = 1.1 and 3.2, respectively; p < 0.001) and hospitalisation (HR = 1.08, p = 0.002, and HR = 1.88, p < 0.001, respectively) in the follow-up period |
| Amitai et al.33 | Prospective cohort study | 61 patients with quiescent small bowel CD since at least three months undergoing MRI and VCE | LI | Progression of bowel damage over time | LI remained stable in the follow-up time (14.8 ± 2.5 months) |
| Ribaldone et al.35 | Retrospective cohort analysis | 91 CD patients were enrolled, 31 (34.1%) treated with adalimumab and 60 (65.9%) with azathioprine (FU time 12 months) | LI | Efficacy of adalimumab and azathioprine in reducing bowel damage | Adalimumab decreased the mean LI score after 12 months (from 9.9 to 8.8), while azathioprine increased it (from 7.7 to 8.8) |
| Rispo et al.37 | Prospective cohort study | 71 patients undergoing MRI and US | LI | Correlation between MRI-based and US-based LI | High correlation between MRI-based and US-based LI score (r = 0.90; p < 0.001) |
| Zorzi et al.28 | Prospective cohort study | 29 patients with ileal or ileo-colonic CD treated with anti-TNF | SLIC | Sensitivity to change of the SLIC | Patients responding to anti-TNFs showed a significant decrease in the SLIC compared to non-responders |
CD: Crohn’s disease; FU: follow-up; TNF: tumour necrosis factor; BD: bowel damage; LI: Lémann Index; IMM: immunomodulators; 5-ASA: 5-aminosalycilic acid; POR: postoperative recurrence; HR: hazard ratio; VCE: video capsule endoscopy; SLIC: sonographic lesion index for CD; US: bowel ultrasound; MRI: magnetic resonance imaging.