Ability of Lamann Score to Evaluate the Damage to the Digestive Tract Caused by Crohnʼs Disease in an Egyptian Cohort

Abstract

Introduction: Lemann score was designed to develop a comprehensive assessment of structural bowel damage, including stricturing, penetrating lesions (fistulas & abscesses), & surgical resection. Methods: Lemann score was calculated in 100 Egyptian CD patients between May 2013 & August 2015. Results: 100 Egyptian CD, 69% males & 31% females, median age 32 y, 36% smokers, 5 % A 1, 55% A2, & 20% A3, 79% L1, 9%, 63% B1,7% B2, 26% B3 & only 4% p. By CDAI, 83% remission, 11% mild,4% moderate, 2% severe. Structural damage of upper GI segment, 4% stricturing lesions, 2% grade 1, & 2% grade 2 lesions. Small bowel, 65% stricturing lesions:39 % grade 1, 23 % grade 2, 3 % grade 3. 25% had grade 3 penetrating lesions, 5% had surgery. Colon/rectum segment, cecum stricturing lesions 3 %, 2% grade 2 & 1% grade 3; ascending colon stricturing lesions 20 %, 7% grade 1, 11% grade 2 & 2% grade 3; transverse colon stricturing lesions 1%; sigmoid colon stricturing lesions 2%; rectum stricturing lesions 1 %; the whole colon 1%, showing grade 1 lesions affecting the 6 segments. For penetrating lesions in the colon, 12% grade 3 lesions. 9 % had surgery. For Anus, only 3% had grade 3 penetrating lesions. Mean Lemann score was 4.02 ± 4.19 & median was 2.Median Lemann score significantly increased with increase disease duration (p < 0.001): 0.60, 2.50, 6.40 for disease duration of < 2 & ≥ 2 - < 10 & ≥10 years respectively. (rs =0.343 & p < 0.001)(KW= 9.235(0.010) (Fig 1& 2).Figure 1Figure 2Conclusion: Pariente B et al,(1) reported Lemann score of 138 CD patients (33.12%, 83.3%, 66.6%,& 42.7%, Upper tract, small bowell, colon/rectum & Anus locations respectively), & median Lemann index significantly increased with disease duration: 6.3,14.3, & 19.0 for disease duration < 2 & ≥ 2 - < 10 & ≥10 years respectively. Conclusions: - Median Lemann score significantly increased with CD disease duration. - Despite calculating Lemann score in Egyptian cohort reflects same positive trend with western cohort but with relatively smaller figures, this could be due to specific environmental or genetic factors or may reflect that Egypt is a young population for CD. 1- 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 Jan;148(1):52-63.