Usefulness of ultrasonography for small intestinal evaluations in pediatric Crohn's disease

Abstract

Background Small bowel capsule endoscopy (SBCE) for Crohn's disease is useful; however, its use has some limitations, such as invasiveness when endoscopic assistance is required in patients who cannot swallow the capsule, and the burden of interpretation on a physician. In contrast, intestinal ultrasonography (IUS) is a non‐invasive modality for children. The purpose of this study is to evaluate the accuracy of IUS for pediatric patients with established Crohn's disease. Methods Small bowel capsule endoscopy and IUS findings from the same period in pediatric patients with established Crohn’s disease were analyzed retrospectively. First, we compared the Lewis score (LS), small bowel endoscopic activity, and IUS findings by small bowel wall thickness (SBWT) and mesenteric lymph node size (MLNS). Second, we compared the performance of IUS findings with those of some biomarkers. Results In 22 procedures, SBWT and MLNS were correlated with LS (r = 0.52, P < 0.05, and r = 0.45, P < 0.05, respectively). Small bowel wall thickness, erythrocyte sedimentation rate, and fecal calprotectin levels had the highest accuracy (81.8%, 81.8%, and 81.8%, respectively). The combination of SBWT and MLNS had the highest positive predictive value and negative predictive value (100% and 83.3%, respectively). Conclusions Intestinal ultrasonography findings, including SBWT and MLNS, are useful for monitoring small bowel lesions in pediatric patients with established Crohn’s disease. We suggest first evaluating small bowel inflammation by IUS in pediatric patients with Crohn’s disease before SBCE because IUS is less invasive than SBCE.

Relevance of sonographic parameters for inflammatory bowel disease in children

“…However, along with abdominal free fluid likely the less specific, as it has been observed also in a greater proportion of non IBD patients. These findings are in keeping with the data of the literature showing that, although more frequently encountered in inflammatory conditions, enlarged lymph nodes and small amounts of abdominal free fluid are common, unspecific and sometimes clinically insignificant findings in children [ 18 ] but may increase anyway the diagnostic confidence and accuracy of IBD when detected along with other findings such as BWT in different clinical context [ 19 ].…”

Oral and Parenteral Vaccination against Escherichia coli in Piglets Results in Different Responses

“…Calprotectin is a heterodimer or homodimer of subunits S100A8 and S100A9, expressed by myeloid cells, especially neutrophils and monocytes [ 23 ]. The usefulness of this biomarker as an indicator of inflammation in various pathologies has long been recognized [ 24 ] and is well correlated with intestinal wall thickening [ 25 ]. It is usually investigated by fecal presence of the protein.…”