Background There is a clinical need to improve monitoring of inflammatory bowel disease (IBD) disease activity. Despite being used regularly in European countries, intestinal ultrasound (IUS) has been implemented less in the United States for unclear reasons. Aims The aim of this study is to illustrate how IUS can be used as a clinical decision-making tool in an American IBD cohort. Methods This retrospective cohort analysis evaluated patients with IBD seen at our institution who underwent IUS as part of routine evaluation of their IBD from July 2020 to March 2022. To evaluate the clinical utility of IUS for different patient populations and against more frequently used measures of inflammation, we compared patient demographics, inflammatory markers, clinical scores, and medications between patients in remission and those with active inflammation. Treatment plans between the two groups were compared and we analyzed patients with follow-up IUS visits to validate treatment plan decisions at initial evaluation. Results Out of 148 total patients with IUS, we found that 62.1% (N=92) of our patients had active disease and 37.9% (N=56) were in remission. UCAI and Mayo scores were both significantly correlated with IUS findings. The treatment plan was significantly correlated with IUS findings (p=0.004). At follow-up, we observed an overall decrease in intestinal thickening, improvements in vascular flow, and mural stratification. Conclusion Clinical decisions incorporating IUS findings effectively reduced inflammation in our IBD patients. IUS should be strongly considered by IBD clinicians in the United States for monitoring disease activity in IBD.

Intestinal ultrasound (IUS) offers a safe, noninvasive, point-of-care tool for diagnosing and monitoring disease activity in patients with inflammatory bowel disease (IBD). IUS is used widely in Europe and Canada for IBD, but it remains underutilized in the United States. Growing interest in IUS in the United States has prompted many IBD centers to train their faculty in IUS. This, however, raises questions about how to effectively use this new tool in the United States, which does not use a social medicine model like those implemented in Europe and Canada. Here, we provide a practical framework for incorporating IUS in an IBD practice in the United States, including training requirements, equipment, and protocols for implementing IUS in daily practice.

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Figure 1. Infliximab vs Adalimumab on Clinical Outcome Measures. Abbreviations: change in (Δ), physician global assessment score (PGA), endoscopic Mayo score (Mayo), histologic disease severity (Histology), not significant (NS)

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