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DOI: 10.1055/s-0033-1347377
Sensitivity of Lennard-Jones criteria in the diagnosis of Crohn's disease
Introduction: Rapid and correct diagnosis of Crohn's disease (CD) is important to impede disease progression however a gold standard is not available. Lennard-Jones et al defined macroscopic and histological criteria which are widely adopted for diagnosis of CD.
Aim: To determine the sensitivity and specificity of the Lennard-Jones criteria for the diagnosis of CD.
Methods: Medical records of patients with long-standing CD managed at 3 different tertiary centres (Nancy, Barcelona and Vienna) were reviewed and re-classified at time of diagnosis (up to 6 month after initial diagnosis of CD by local standards) according to Lennard-Jones criteria. In detail, CD was rated as “established” (granuloma + one minor criterion or 3 minor criteria, which include macroscopic discontinuity, transmural inflammation, fibrosis, lymphoid aggregates or discontinuous inflammation on histology), “probable” (2 minor criteria without granulomas) or “non CD”. Sensitivity and specificity were calculated including patients with ulcerative colitis (UC) as controls.
Results: Overall, 343 patients with CD and 170 patients with UC were included. At time of diagnosis nearly half of all patients were diagnosed as “non CD” (see Table 1).
Sensitivity of Lennard-Jones criteria varied from 0.21 to 0.66 dependent upon centre and scope of description. Pooling patients from all centres resulted in a maximum sensitivity of 0.50 when combining “established CD” and “probable CD” for the diagnosis of CD.
Conclusion: Nearly half of patients with long-standing diagnosis of CD are missed by the Lennard-Jones criteria at time of diagnosis. The Lennard-Jones criteria are not sensitive enough to fulfil the demand of early treatment of CD. Thus, there is dire need for prospectively validated diagnostic criteria of early CD.
Established CD, n (%) |
Probable CD, n (%) |
Non CD, n (%) |
|
Barcelona |
49/101 (48.5%) |
18/101 (17.8%) |
34/101 (33.7%) |
Nancy |
21/100 (21%) |
21/100 (21%) |
58/100 (58%) |
Vienna |
46/142 (32%) |
17/142 (12%) |
79/142 (56%) |