Utility of Intestinal Ultrasound in Clinical Decision-Making for Inflammatory Bowel Disease

Abstract

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.

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

“…In UC, as opposed to CD, the clinical scores significantly correlate with disease activity as determined by IUS [6,94].…”

“…Non-invasive procedures include clinical parameters (different for CD and UC), blood (erythrocyte sedimentation rate-ESR; C-reactive protein-CRP), and stool (faecal calprotectin-FC) examinations. A plethora of biomarkers (such as genetic, metabolic, and bacterial flora) have been intensely studied, but they have yet to be put into use due to their contradictory results [6][7][8].…”

Integrating Intestinal Ultrasound into an Inflammatory Bowel Disease Practice: How to Get Started

“…In contrast, IUS is noninvasive and evaluates the morphology of all layers of the intestinal wall while providing insight into mural stratification, bowel wall thickness, mesenteric fat, lymph nodes, and blood flow as assessed by doppler. 2 In stricturing disease, dilation of the proximal lumen can be seen in addition to conglomeration of loops, adjacent fistulas, and abscesses. Additional modalities, such as doppler ultrasound or contrast-enhanced ultrasound, can be used to examine intramural blood flow and differentiate between active inflammation and fibrotic mucosa.…”

“…Additionally, IUS can be used for long-term disease activity monitoring, especially due to the lack of correlation between symptoms and noninvasive objective markers of disease activity, allowing for prompt and early change in IBD treatment. 2 In what follows, we briefly summarize the evidence for IUS’s utility and provide a practical framework for implementing IUS in clinical practice in the United States.…”

Advancing transmural remission as a treatment target in Crohn's disease: The future of tight‐control strategy?

“…16 Furthermore, its diagnostic accuracy approaches that of more elaborate conventional radiological examinations like MRE. 17,18 It is worth noting that other studies have already demonstrated the efficacy of clinical decision-making involving IUS findings in reducing inflammation in patients with IBD, 19 and IUS is increasingly finding application in CD management, [20][21][22] underscoring its potential utility as a pivotal tool in striving for transmural remission. Inflammatory bowel disease gastroenterologists should be encouraged to consider transmural remission as a viable treatment goal for CD management.…”