Relevance of sonographic parameters for inflammatory bowel disease in children

Abstract

Purpose Intestinal ultrasound (IUS) is widely used as the first exam in patients with suspected inflammatory bowel disease (IBD). This study investigated the accuracy of several IUS parameters, including increased bowel wall thickening (BWT), in detecting IBD in a paediatric population. Methods The study included an unselected series of 113 patients aged 2–18 years (mean age 10.8 years, 65 male), referred for recurrent abdominal pain or altered bowel habits, without known organic diseases, to perform an IUS as first investigation of a diagnostic workup. Patients with full systematic IUS examination, clinical and biochemical exams, and ileocolonoscopy or an uneventful follow-up at least one year follow up were eligible. Results 23 IBD patients (20.4%; 8 ulcerative colitis, 12 Crohn’s disease and 3 indeterminate colitis) were diagnosed. We found that increased BWT > 3 mm (OR 5.4), altered IUS bowel pattern (IUS-BP, OR 9.8) and mesenteric hypertrophy (MH, OR 5.2) accurately identified IBD at the multivariate analysis. IUS-BP, MH and BWT > 3 mm had a sensitivity of 78.3%, 65.2% and 69.6% and a specificity of 93.3%, 92.2% and 96.7%, respectively. The combination of these three alterations increased the specificity up to 100%, whilst decreased sensitivity to 56.5%. Conclusion Among several US parameters suggestive of IBD, the increased BWT, MH and altered echopattern are independent predictors of IBD. The ultrasonographic diagnosis of IBD could be more accurate if relied on combination of different sonographic parameters, than on the sole BWT evaluation.

The importance of Doppler ultrasound in pediatric inflammatory bowel disease

“…That means that the examination can be performed by different doctors, with reproducibility, making it possible to compare results between observers and between time points, thus reducing subjectivity and increasing accuracy. The article also demonstrated that the correlation between color Doppler ultrasound of the intestinal wall and the fecal calprotectin level shows high sensitivity and specificity for identifying inflammatory activity in pediatric IBD, corroborating data in the literature (1) .…”

“…Inflammatory bowel diseases (IBDs) comprise a group of diseases that cause chronic inflammation of the intestine, including Crohn's disease, ulcerative colitis, and inflammatory bowel disease unclassified. The incidence and prevalence of IBDs have increased over the last 50 years, with an incidence of 25% in the pediatric population, being more aggressive in this age group (1) .…”

“…In addition to the data obtained with color Doppler, ultrasound provides other important information in the evaluation of patients with IBD, with emphasis on the determination of the wall thickness in the bowel loops, the presence of regional lymph nodes, hypertrophy of the adipose tissue of the mesentery and the presence of free fluid in the peritoneal cavity (1) , as well as complications arising from the underlying disease.…”

Novelties and Perspectives of Intestinal Ultrasound in the Personalised Management of Patients with Inflammatory Bowel Diseases—A Systematic Review

“…The particularities of the inflammatory reaction increase the relevance of altered bowel pattern, mesenteric fat hypertrophy and lymph node enlargement in children. However, these findings are highly non-specific, and their presence alone should not be considered an absolute diagnostic marker [37,40]. Radiological remission in this group has also been suggested to greatly reduce the risk of recurrence or complications [52,105].…”