The role of the intestinal ultrasound in Crohn’s disease diagnosis and monitoring

Abstract

Crohn’s disease is characterized by persistent or recurrent chronic inflammation that may affect any segment of the gastrointestinal tract. It has an oscillating evolution, with periods of activity alternating with periods of remission. Crohn’s disease has a significant impact on the economic status due to its increasing prevalence, often affecting young people. Suitable management for these patients involves frequent evaluations. Even though colonoscopy is the gold standard for the assessment of severity and mucosal healing, it is an invasive maneuver, not easily accepted by patients, and it does not have good repeatability. Intestinal ultrasound has the advantage of being non-irradiating, non-invasive, well-tolerated, cheap, and easy to repeat. Ultrasound parameters such as bowel wall thickness, intestinal wall architecture, intramural vascularisation, proliferation of mesenteric fatty conjunctive tissue, and intraperitoneal fluid can provide good information regarding the severity of the disease, the differentiation between remission and relapse, and its complications. Some of the latest studies show good correlations between ultrasound parameters and inflammation markers (C-reactive protein, fecal calprotectin) and clinical severity scores of Crohn’s disease. Consequently, the importance of intestinal ultrasound has increased lately, and recent studies support its use to evaluate the severity of inflammation, differentiate between active disease and relapse, monitor therapy response and guide treatment, evaluate prognosis, and diagnose complications.

Doença de Crohn - uma revisão abrangente sobre etiologia, epidemiologia, diagnóstico, tratamento farmacológico e tratamento cirúrgico

“…Ressonância magnética, tomografia computadorizada, ultrassonografia e radiologia com contraste em bário são exames complementares que fornecem precisão semelhante para o diagnóstico inicial, monitoramento da atividade da doença e identificação de complicações, como fístulas e abscessos. Se os exames endoscópicos e complementares não possibilitarem o diagnóstico e houver alta suspeita de DC no intestino delgado, a cápsula endoscópica seguida de uma enteroscopia com balão para obter biópsias é útil (Spiceland;Nilesh Lodhia, 2018, Veauthier;Hornecker, 2018, Cushing;Higgins, 2021, Norbert Dacian Stenczel et al, 2021.…”

In-hospital management of inflammatory bowel disease

“…The diagnosis of small bowel obstruction is typically made based on plain abdominal radiography or cross-sectional imaging [98]. Intestinal ultrasonography has gained momentum as an accurate, noninvasive, point-of-care diagnostic modality for identifying distal fibrostenotic strictures, abscesses, and fistula [99,100]. The initial inpatient management of fibrostenotic Crohn's disease requires initiation of corticosteroids if an inflammatory component is present [90,101].…”

Predicting Treatment Response in Inflammatory Bowel Diseases: Cross-Sectional Imaging Markers

“…BWT increases as a direct expression of wall inflammation, especially in CD, due to the transmural nature of the disease [ 7 ]. Furthermore, a distortion of the normal wall architecture may be present in active disease, as may the presence of increased vascular signals and direct signs of neo-angiogenesis related to disease activity [ 16 ]. In particular, the latter is measured with Doppler ultrasonography, and the most frequently used score is the Limberg score, which provides a semi-quantitative characterization, categorizing the vascularization of the wall from 0 to 4 [ 17 ].…”