Intestinal ultrasound detects ulcerative colitis treatment response better than endoscopy: Study

Netherlands: A recent study conducted by Floris de Voogd and his peers found intestinal ultrasound (IUS) to pick up bowel wall thickness (BWT) better and was also found to be very accurate in detecting treatment response when compared with endoscopy. The findings of this study were published in Gastroenterology. 

Colonic ultrasound is a non-invasive, inexpensive, and accurate for determining disease activity in ulcerative colitis (UC). In this study, investigators prospectively assessed his IUS treatment response in a longitudinal cohort using endoscopy and histology as the gold standard.

Consecutive patients with moderate-to-severe ulcerative colitis (endoscopic Mayo score (EMS) ≥2) who initiated tofacitinib treatment were included in this study. Patients underwent clinical, biochemical, endoscopic (EMS and Ulcerative Colitis Endoscopic Severity Index (UCEIS)), histological (Roberts Histopathological Index (RHI)), and IUS evaluations. They were evaluated at baseline and after 8 weeks of tofacitinib induction using IUS, endoscopy, and histology readers were blinded to all other results. The primary endpoint was the difference in bowel wall thickness between endoscopic improvement and no endoscopic improvement. Endoscopic remission was defined as EMS=0, improvement as EMS≤1, and response as EMS≥1 decrease.

The main highlights of this study were:

1. Thirty patients were enrolled and 27 completed follow-ups.

2. BWT correlated with EMS (ρ=0.68), UCEIS (ρ=0.73), and RHI (ρ=0.49) at both time points.

3. BWT of the sigmoid colon was lower in patients with endoscopic remission (1.4 mm vs. 4.0 mm) and endoscopic improvement (1.8 mm vs. 4.5 mm); It was more pronounced in the following patients with an endoscopic response (-58.1% vs -13.4%).

4. The most accurate cut-offs for BWT were 2.8 mm (AUC: 0.87) for endoscopic remission, 3.9 mm (AUC: 0.92) for improvement, and 32% (AUC: 0.87) reduction for response.

5. The submucosa was the most responsive wall layer.

In conclusion, The Authors found colonic ultrasound to be superior to endoscopy in analyzing treatment response and remission in patients with ulcerative colitis. 

Reference: 

de Voogd, F., van Wassenaer, E. A., Mookhoek, A., Bots, S., van Gennep, S., Löwenberg, M., D'Haens, G. R., & Gecse, K. B. (2022). Intestinal ultrasound is accurate to determine endoscopic response and remission in patients with moderate to severe ulcerative colitis: a longitudinal prospective cohort study. In Gastroenterology. Elsevier BV. https://doi.org/10.1053/j.gastro.2022.08.038