Ultrasonographic Evaluation of Intestinal Fibrosis and Inflammation in Crohn’s Disease. The State of the Art

Abstract

The evaluation of the degree of inflammation and fibrosis, intrinsic elements in intestinal wall damage of Crohn’s disease, is essential to individuate the extent of the lesions and the presence of strictures. This information will contribute to the choice of the appropriate therapeutic approach, the prediction of the response to therapy and the course of the disease. The accurate evaluation of the extent and severity of inflammation and/or fibrosis in Crohn’s disease currently requires histopathological analysis of the intestinal wall. However, in clinical practice and research, transmural assessment of the intestinal wall with cross sectional imaging is increasingly used for this purpose. The B-mode ultrasonograhic characteristics of the intestinal wall, the assessment of its vascularization by color Doppler and I.V. contrast agents, and the evaluation of the mechanical and elastic properties by sonoelastography, may provide useful and accurate information on the severity and extent of inflammation and intestinal fibrosis in Crohn’s disease. The purpose of this review is to provide an update on current sonographic methods to discriminate inflammation and fibrosis in Crohn’s disease.

Ultrasonography in inflammatory bowel disease – So far we are?

“…IUS with special applications such as elastography and contrast enhanced ultrasound appears to be promising, but solid data from prospective multi‐centre trials are an unmet need especially considering that new anti‐fibrotic drugs are in the development pipeline. 27 , 28 , 29 , 30 …”

Intestinal strictures in Crohn’s disease: a 2021 update

“…Recently, US has gained much attention in distinguishing fibrosis because of its noninvasive and nonradiating nature. 55 Bhatnagar et al 56 examined the association between sonographic features and histopathological scores, and revealed that submucosal layer echogenicity, clarity, and mucosal layer thickness were associated with intestinal fibrosis. Besides, the changes in intestinal tissue stiffness were positively correlated with the severity of fibrosis, with a correlation coefficient of 0.73.…”

Network pharmacology and molecular docking reveal zedoary turmeric-trisomes in Inflammatory bowel disease with intestinal fibrosis

“…Due to the destruction of the epithelial barrier observed in IBD, intestinal bacterial products penetrate the stroma, and the epithelial gap induced by immune cells and immune cell activation mediates the innate immune response[ 4 ]. Changes in environmental factors and chronic inflammation due to repeated stimulation result in obvious changes in intestinal extracellular matrix components and, through their mechanical properties, facilitate the formation of fibrosis[ 5 ]. The traditional view that intestinal fibrosis is an inevitable and irreversible process is gradually changing based on studies of its underlying pathological, cellular and molecular mechanisms[ 6 ].…”