Intestinal Ultrasound in Inflammatory Bowel Disease: A Valuable and Increasingly Important Tool

Abstract

<b><i>Background:</i></b> Intestinal ultrasound is emerging as a non-invasive tool for monitoring disease activity in inflammatory bowel disease patients due to its low cost, excellent safety profile, and availability. Herein, we comprehensively review the role of intestinal ultrasound in the management of these patients. <b><i>Summary:</i></b> Intestinal ultrasound has a good accuracy in the diagnosis of Crohn’s disease, as well as in the assessment of disease activity, extent, and evaluating disease-related complications, namely strictures, fistulae, and abscesses. Even though not fully validated, several scores have been developed to assess disease activity using ultrasound. Importantly, intestinal ultrasound can also be used to assess response to treatment. Changes in ultrasonographic parameters are observed as early as 4 weeks after treatment initiation and persist during short- and long-term follow-up. Additionally, Crohn’s disease patients with no ultrasound improvement seem to be at a higher risk of therapy intensification, need for steroids, hospitalisation, or even surgery. Similarly to Crohn’s disease, intestinal ultrasound has a good performance in the diagnosis, activity, and disease extent assessment in ulcerative colitis patients. In fact, in patients with severe acute colitis, higher bowel wall thickness at admission is associated with the need for salvage therapy and the absence of a significant decrease in this parameter may predict the need for colectomy. Short-term data also evidence the role of intestinal ultrasound in evaluating therapy response, with ultrasound changes observed after 2 weeks of treatment and significant improvement after 12 weeks of follow-up in ulcerative colitis. <b><i>Key Messages:</i></b> Intestinal ultrasound is a valuable tool to assess disease activity and complications, and to monitor response to therapy. Even though longer prospective data are warranted, intestinal ultrasound may lead to a change in the paradigm of inflammatory bowel disease management as it can be used in a point-of-care setting, enabling earlier intervention if needed.

The Diagnostic Utility of Biochemical Markers and Intestinal Ultrasound Compared with Endoscopy in Patients with Crohn’s Disease and Ulcerative Colitis: A Systemic Review and Meta-Analysis

“…Additionally, endoscopic procedures demonstrated a pooled sensitivity and specificity of 60% (95% CI, 52 to 68%) and 82% (95% CI, 76 to 87%), respectively. Of note, the sensitivity of 60% in detecting inflammation suggests that microscopic disease activity may elude detection via endoscopy [ 39 , 40 ]. Conversely, the higher specificity of 82% is valuable in excluding inflammation in patients with inflammatory bowel disease (IBD).…”

Reclassification of Inflammatory Bowel Disease Type Unclassified by Small Bowel Capsule Endoscopy

“…Intestinal ultrasound (IUS) is a rapidly gaining recognition as a non-invasive diagnostic technique, featuring several inherent strengths including widespread accessibility and a strong safety profile [17]. Due to its capacity to detect intestinal inflammation, achieved through the measurement of bowel wall thickness, the detection of changes in bowel stratification, increased vascularization, and the description of extramural features, IUS is a very helpful method for IBD diagnosis.…”

Utility of four machine learning approaches for identifying ulcerative colitis and Crohn's disease

“…Endoscopic investigation, radiological imaging and histological analysis are regularly used in the clinic to observe intestinal inflammation [ 10 ]. Endoscopy is an efficient approach to assessing the persisting inflammation in individuals with IBD [ 11 ]; unfortunately, its time-consuming, expensive and invasive features may not be tolerated by patients [ 12 ]. Confocal laser endoscopy can differentiate between mucosal lesions of CD and UC.…”