Gastroenterology: Intestinal ultrasound accurately determines endoscopic response and disease remission in patients with moderate to severe ulcerative colitis

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by repeated recurrences
of the disease.
Clinical symptoms, blood tests, stool markers, CT cross-sectional imaging, endoscopy, and histopathology are most commonly used to determine disease activity and severity
.
During follow-up, researchers advocate close monitoring to assess treatment effectiveness and detect early recurrence
.
Endoscopy is generally considered the gold standard
for diagnosis and follow-up of UC patients.
However, endoscopy is an invasive and costly procedure
.
Noninvasive fecal biomarkers, most commonly fecal calcium-protective protein (FCP), are often used to determine the presence of inflammation and response
to treatment.
Intestinal ultrasound (IUS) is a non-invasive, easily accessible, and inexpensive alternative to visualize the colon and determine disease activity, degree, and therapeutic response without bowel preparation
.
Recent studies have shown that IUS can detect treatment response up to two weeks after initiation of anti-inflammatory therapy compared to clinical response
.
In this study, researchers prospectively assessed the treatment response
of IUS in a longitudinal cohort by using endoscopy and histology as the gold standard.

The investigators successively included patients
who started tofacitinib with moderate to severe UC (endoscopic Mayo score [EMS] ≥ 2).
The degree of inflammatory activity was assessed by clinical, biochemical, endoscopic (EMS and UC endoscopic severity index), histologic (Robarts histopathological index), and IUS, and response to treatment was assessed
at baseline and 8 weeks after tofacitinib induction.
The primary observation was the difference
in intestinal wall thickness (BWT) for endoscopic improvement versus non-endoscopic improvement.
Endoscopic response is defined as EMS=0, improvement as EMS ≤1, and response as EMS reduction ≥1
.

A total of 30 patients were included in the study, of which 27 completed follow-up
.
BWT was > to EMS (ρ=0.
68, P<.
0001 .
0001 robarts bwt vs mm at both time points

This study confirms that IUS, particularly intestinal wall thickness (BWT), is one of the most important parameters that can detect response to treatment with a high degree of accuracy when evaluated based on endoscopic results
.

Original source:

Floris de Voogd.
et al.
Intestinal Ultrasound Is Accurate to Determine Endoscopic Response and Remission in Patients With Moderate to Severe Ulcerative Colitis: A Longitudinal Prospective Cohort Study.
Gastroenterology.
2022.