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TitleLewis Score - Prognostic value in patients with isolated small bowel Crohn's disease
Author(s)Castro, F. Dias de
Carvalho, Pedro Boal
Monteiro, Sara
Rosa, Bruno
Firmino-Machado, João
Moreira, Maria João
Cotter, José de Almeida Berkeley
KeywordsCrohn’s disease
Small bowel capsule endoscopy
Lewis score
Lewis score; prognosis
Issue dateOct-2015
PublisherOxford University Press
JournalJournal of Crohn's and Colitis
Citationde Castro, F. D., Carvalho, P. B., Monteiro, S., Rosa, B., Firmino-Machado, J., Moreira, M. J., & Cotter, J. (2015). Lewis Score–prognostic value in patients with isolated small bowel Crohn’s disease. Journal of Crohn's and Colitis, 9(12), 1146-1151
Abstract(s)Background and aims: Small bowel capsule endoscopy (SBCE) allows mapping of small bowel inflammation in Crohn’s disease (CD). We aimed to assess the prognostic value of the severity of inflammatory lesions, quantified by the Lewis score (LS), in patients with isolated small bowel CD. Methods: A retrospective study was performed in which 53 patients with isolated small bowel CD were submitted to SBCE at the time of diagnosis. The Lewis score was calculated and patients had at least 12 months of follow-up after diagnosis. As adverse events we defined disease flare requiring systemic corticosteroid therapy, hospitalization and/or surgery during follow-up. We compared the incidence of adverse events in 2 patient subgroups, i.e. those with moderate or severe inflammatory activity (LS =790) and those with mild inflammatory activity (135 = LS < 790). Results: The LS was =790 in 22 patients (41.5%), while 58.5% presented with LS between 135 and 790. Patients with a higher LS were more frequently smokers (p = 0.01), males (p = 0017) and under immunosuppressive therapy (p = 0.004). In multivariate analysis, moderate to severe disease at SBCE was independently associated with corticosteroid therapy during follow-up, with a relative risk (RR) of 5 (p = 0.011; 95% confidence interval [CI] 1.5–17.8), and for hospitalization, with an RR of 13.7 (p = 0 .028; 95% CI 1.3–141.9). Conclusion: In patients with moderate to severe inflammatory activity there were higher prevalences of corticosteroid therapy demand and hospitalization during follow-up. Thus, stratifying the degree of small bowel inflammatory activity with SBCE and LS calculation at the time of diagnosis provided relevant prognostic value in patients with isolated small bowel CD.
Publisher version
AccessOpen access
Appears in Collections:ICVS - Artigos em revistas internacionais / Papers in international journals

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