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Bowel Damage in Patients With Long-term Crohn`s Disease, Assessed by Magnetic Resonance Enterography and the Lemann Index.

Artigo em Inglês | MEDLINE | ID: mdl-28694130

Resumo

BACKGROUND AND AIMS: Magnetic Resonance Enterography (MRE) is used to evaluate the extent and complications of Crohn's disease (CD) and has recently been included in a score for bowel damage, the Lemann Index (LI). The long-term outcomes of CD are still uncertain and we aimed to assess the structural bowel changes after 20 years of CD by means of MRE and LI score. METHODS: We performed a follow-up analysis of a population-based cohort of 237 patients in southeastern Norway diagnosed with CD from 1990 through 1993. Twenty years after diagnosis, 156 attended the evaluation in which they were offered routine clinical blood testing and colonoscopy. Ninty-six patients were examined with MRE and LI score was calculated. The independent association of the LI score with clinical variables was examined by univariate analysis RESULTS: Sixty-five patients (67.7%) had CD manifestations on MRE (36.9%), colonoscopy (29.2%) or both (33.9%). MRE findings changed the disease classification in 8 patients (8.3%). The median LI score was 4.6 (interquartile range: 0-59.8) and it associated with younger age (P=.02), complicated ileocolonic phenotype (P<.001) and biological (P<.001) and immunosuppressant therapy (P=.045). Independent predictors for LI score in the course of the follow-up were age, complicated disease behavior, medication use and inflammatory biomarkers. CONCLUSIONS: Two thirds of the examined patients had CD related findings, half of which was only detectable by MRE. The LI score associated with ongoing active disease. Young age, complicated disease and persistent inflammation were predictive of bowel damage.