Monitoring Inflammatory Bowel Disease in Pregnancy Using Gastrointestinal Ultrasonography

Abstract

Background and Aims Inflammatory bowel disease [IBD] affects women during their childbearing years. Gastrointestinal ultrasonography [GIUS] accurately identifies disease activity in non-pregnant patients with IBD. The utility of GIUS in pregnancy has not been established. We aimed to determine the feasibility and accuracy of GIUS in the assessment of IBD during pregnancy progression. Methods A multicentre observational study of women with IBD undergoing GIUS during pregnancy. Clinicians assessed the adequacy of bowel views and disease activity in four colonic segments and the terminal ileum. Location[s] in which views were impeded by the uterus were documented. GIUS disease activity [bowel wall thickness >3 mm] was compared with biochemical disease activity [faecal calprotectin >100 μg/g]. Results Ninety patients and 127 GIUS examinations were included [median gestation 19 weeks, range 4–33]. Adequate colonic views were obtained in 116/127 [91%] scans. Adequate ileal views were obtained in 62/67 [93%] scans <20 weeks and 30/51 [59%] scans at 20–26 weeks. There was a positive correlation between bowel wall thickness and calprotectin [r = 0.26, p = 0.03]. GIUS delivered a specificity of 83%, sensitivity of 74%, and negative predictive value of 90% compared with calprotectin. Conclusions GIUS is a feasible and accurate modality for monitoring IBD in pregnancy. Adequate GIUS views of the colon and terminal ileum can be obtained in the majority of patients up to 20 weeks of gestation. Beyond 20 weeks, GIUS provides good views of the colon but the terminal ileum becomes difficult to assess.

Role of Intestinal Ultrasound in the Management of Patients with Inflammatory Bowel Disease

“…ECCO-ESGAR guidelines recommend IUS and MRE without intravenous gadolinium as the safest techniques to examine pregnant women in whom IBD is known or suspected, regardless of the trimester [ 1 ]. A multicenter observational study of women with IBD undergoing IUS during pregnancy assessed the bowel visualization in four colonic segments and in terminal ileum, showing IUS as a feasible and accurate method to monitor IBD during pregnancy [ 42 ]. Bowel wall thickness was compared with fecal calprotectin in pregnant women < 20 weeks, with an adequate visualization of colonic segments in 116/127 (91%) and of terminal ileum in 62/67 (93%) of IUS examinations.…”

Altered bowel habit and rectal bleeding in pregnancy: the importance of recognising undiagnosed inflammatory bowel disease

“…Exposure to radiation during pregnancy is ideally avoided, but if there are systemic features to suggest toxic megacolon, an abdominal X‐ray is warranted 3,9 . Intestinal ultrasound is emerging as a safe modality for the evaluation of colonic disease activity, foetal viability and growth parameters, but is limited for isolated rectal or distal sigmoid disease, and for assessment of the terminal ileum beyond 20 weeks' gestation 3,10,11 . Magnetic resonance imaging without gadolinium is considered safe, but experience in UC remains scant.…”

Evaluation and management of rectal bleeding in pregnancy

“…Faecal calprotectin, a granulocyte neutrophil‐predominant cytosolic protein, is an established marker of intestinal inflammation, used broadly in the diagnosis and monitoring of inflammatory bowel disease and as a discriminator between functional and inflammation‐driven gastrointestinal symptoms 17 . Faecal calprotectin levels do not change with pregnancy, so can be used reliably in this setting as a diagnostic and monitoring tool 18,19 . In women aged between 16–50 years presenting with gastrointestinal symptoms, a faecal calprotectin level of ≥ 50 µg/g can differentiate between inflammatory bowel disease and functional gastrointestinal disorders with a negative predictive value of 0.99 20 …”

“…Imaging evaluation of rectal bleeding is predominantly useful in suspected inflammatory bowel disease or staging of colorectal carcinoma, although with modest value for the former. Intestinal ultrasound can be accurately used by experienced operators in the first and second trimesters of pregnancy 18 . Intestinal ultrasound can assess the colonic wall segments and small bowel for inflammatory changes; however, its utility in adequately assessing isolated rectal inflammation in pregnancy is limited 18 …”

“…Intestinal ultrasound can be accurately used by experienced operators in the first and second trimesters of pregnancy 18 . Intestinal ultrasound can assess the colonic wall segments and small bowel for inflammatory changes; however, its utility in adequately assessing isolated rectal inflammation in pregnancy is limited 18 …”