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Tian J, Wang W, Liu Y, Zhang X, Zhao H, Qu H. Role of endoscopic ultrasound as a predictor of histological healing in ulcerative colitis. Ann Med 2025; 57:2499961. [PMID: 40305512 PMCID: PMC12044909 DOI: 10.1080/07853890.2025.2499961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Revised: 04/01/2025] [Accepted: 04/14/2025] [Indexed: 05/02/2025] Open
Abstract
BACKGROUND Ulcerative colitis (UC) is a chronic inflammatory bowel disease with rising global prevalence.Histological healing (HH) is a key treatment target associated with better long-term outcomes. Although endoscopic ultrasound (EUS) is known to be related to both clinical and endoscopic activity in UC, its role in defining HH remains unclear. Therefore, this study was aimed at investigating the association between EUS and histological activity (HA), as well as the predictive potential of EUS for HH. METHOD In this cross-sectional analysis, 68 UC adults underwent EUS and colonoscopy with biopsies. We used the Mayo Endoscopic Score (MES) for endoscopic activity, the Nancy Index (NI) for biopsy grading, and the Endoscopic Ultrasound-Ulcerative Colitis (EUS-UC) score for EUS analysis, defining endoscopic remission as MES ≤ 1 and HH as NI ≤ 1.A receiver operating characteristic (ROC) curve was employed to evaluate the ability of the indices to predict HH. RESULTS Totally 23 patients (33.80%) achieved HH, while 45 (66.20%) showed HA. The EUS-UC scores were significantly lower in the HH group (p < 0.001) and correlated strongly with NI (ρ = 0.73). EUS-UC score was an independent risk factor for HH (adjusted OR = 1.918, 95% CI: 1.195-3.080, p = 0.007). The EUS-UC score demonstrated a strong predictive value for HH, with an AUC of 0.840, a sensitivity of 75.56%, and a specificity of 78.26%. CONCLUSION The EUS-UC score has a significant correlation with histological outcomes and shows strong potential as a reliable, invasive predictor of HH in UC, with implications for improved disease monitoring.
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Affiliation(s)
- Jin Tian
- School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong, China
| | - Wei Wang
- Department of Gastroenterology, the First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, Shandong, China
| | - Yongshuai Liu
- Department of Gastroenterology, the First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, Shandong, China
| | - Xin Zhang
- School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong, China
| | - Hanqing Zhao
- School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong, China
| | - Hongmei Qu
- Department of Gastroenterology, the First Affiliated Hospital of Shandong Second Medical University, Weifang People’s Hospital, Weifang, Shandong, China
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2
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Pal P, Mateen MA, Sekaran A, Pooja K, Kaleemuddin A, Rangineni T, Basha J, Gupta R, Tandan M, Lakhtakia S, Reddy DN. Can transperineal ultrasound replace endoscopic ultrasound in staging distal ulcerative colitis? Gut 2025:gutjnl-2025-335681. [PMID: 40360232 DOI: 10.1136/gutjnl-2025-335681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2025] [Accepted: 05/01/2025] [Indexed: 05/15/2025]
Affiliation(s)
- Partha Pal
- Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | | | - Anuradha Sekaran
- Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Kanapuram Pooja
- Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | | | - Thanmayee Rangineni
- Department of Pathology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Jahangeer Basha
- Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Rajesh Gupta
- Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Manu Tandan
- Asian Institute of Gastroenterology, Hyderabad, Telangana, India
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Dolinger MT, Aronskyy I, Spencer EA, Pittman N, Dubinsky MC. Early intestinal ultrasound response to biologic and small molecule therapy is accurate to predict treat-to-target endoscopic outcomes in children with ulcerative colitis: results from the prospective super sonic-UC study. J Crohns Colitis 2025; 19:jjaf075. [PMID: 40312920 DOI: 10.1093/ecco-jcc/jjaf075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Indexed: 05/03/2025]
Abstract
BACKGROUND AND AIMS Stride-II recommends monitoring early biomarker targets to achieve treat-to-target (T2T) endoscopic remission (ER) in ulcerative colitis (UC). Predictive capabilities of intestinal ultrasound (IUS) for ER remain unknown. We evaluated IUS response to predict ER in children with UC. METHODS Prospective longitudinal cohort study of children with UC (Mayo endoscopic score [MES ≥2) starting advanced therapy undergoing IUS (including Milan Ultrasound Criteria [MUC], Civitelli Ulcerative Colitis Index, and International Bowel Ultrasound Group Segmental Activity Score), fecal calprotectin (FC), C-reactive protein (CRP), and Pediatric Ulcerative Colitis Activity Index at baseline, week 8, and T2T. Primary outcome was accuracy to predict T2T ER (MES = 0) for change in bowel wall thickness (BWT) from baseline to week 8, and absolute BWT at week 8. Logistic regression with forward selection determined an optimal prediction model for endoscopic outcomes. RESULTS Of 42 children, 21 (50%) achieved ER. Week 8 BWT ≤ 2.7 mm (OR 6.4 [95% CI, 1.8-27.0], P = .007), MUC < 6.0 (OR 5.7 [95% CI, 1.5-25.3], P = .015), and FC ≤ 177 (OR 4.5 [95% CI, 1.1-23.6], P = .049) were associated with ER. CONCLUSIONS Combining noninvasive biomarkers of BWT and the MUC on IUS, and FC, is a feasible tight control monitoring strategy in children with UC that is predictive of endoscopic outcomes. Larger, multicenter validation studies are needed to understand how an IUS and FC monitoring strategy may improve outcomes in children with UC.
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Affiliation(s)
- Michael Todd Dolinger
- Division of Pediatric Gastroenterology, Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Illya Aronskyy
- Division of Pediatric Gastroenterology, Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Elizabeth A Spencer
- Division of Pediatric Gastroenterology, Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nanci Pittman
- Division of Pediatric Gastroenterology, Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Marla C Dubinsky
- Division of Pediatric Gastroenterology, Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Wild J, Nandi N, Chew TS, Rea B, Sidhu R. Small bowel ultrasound: friend or foe? Curr Opin Gastroenterol 2025; 41:154-163. [PMID: 39998917 DOI: 10.1097/mog.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2025]
Abstract
PURPOSE OF REVIEW Crohn's disease (CD), requires accurate diagnosis and regular monitoring to manage disease activity, prevent complications, and improve outcomes. Intestinal ultrasound (IUS) has emerged as a noninvasive, real-time imaging modality, offering a valuable alternative to traditional diagnostic techniques such as magnetic resonance enterography (MRE), endoscopy and capsule endoscopy (CE). This review examines recent advances in IUS for the diagnosis and monitoring of small bowel CD, with a focus on its applications, benefits, and limitations. RECENT FINDINGS Recent studies have demonstrated that IUS provides high sensitivity and specificity in detecting key markers of disease activity, including bowel wall thickness (BWT), bowel wall flow (BWF), and bowel wall stratification (BWS). Advances in IUS techniques, such as elastography and contrast-enhanced ultrasound (CEUS), have expanded its diagnostic and prognostic capabilities, potentially enabling differentiation between inflammation and fibrosis. However, challenges remain, including operator dependency, variability in scoring systems, and reduced sensitivity for superficial mucosal abnormalities. Efforts to standardize parameters and improve training have shown promise in addressing these limitations. SUMMARY IUS is a critical complementary tool for assessing disease activity, transmural healing, and postoperative recurrence in small bowel CD. Its noninvasiveness, cost-effectiveness, and real time assessment make it well suited for routine clinical use. Nonetheless, further multicentre studies are needed to validate scoring systems, optimize integration with other modalities, and improve consistency across clinical settings. IUS holds significant potential for advancing personalized care in small bowel CD, though ongoing research is required to refine its applications and maximize its clinical utility.
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Affiliation(s)
| | - Nicoletta Nandi
- Academic Unit of Gastroenterology and Hepatology, Sheffield Teaching Hospitals, NHS Foundation Trust
| | - Thean Soon Chew
- Academic Unit of Gastroenterology and Hepatology, Sheffield Teaching Hospitals, NHS Foundation Trust
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | | | - Reena Sidhu
- Academic Unit of Gastroenterology and Hepatology, Sheffield Teaching Hospitals, NHS Foundation Trust
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
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Madsen GR, Wilkens R, Attauabi M, Ilvemark JFKF, Theede K, Bjerrum JT, Bendtsen F, Seidelin JB, Boysen T, Burisch J. Intestinal ultrasound as a prognostic tool in new-onset ulcerative colitis-a Copenhagen IBD Cohort Study. J Crohns Colitis 2025; 19:jjaf033. [PMID: 40036961 DOI: 10.1093/ecco-jcc/jjaf033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Indexed: 03/06/2025]
Abstract
BACKGROUND AND AIMS This study assesses the prognostic role of intestinal ultrasound (IUS) in determining the disease course of ulcerative colitis (UC) in the first year after diagnosis. METHODS A prospective, multicenter population-based inception cohort study was conducted on patients newly diagnosed with UC. Patients with left-sided or extensive UC underwent IUS assessments at diagnosis, 3 months, and 12 months, alongside symptomatic, biochemical, and endoscopic evaluations. Transmural remission was defined as bowel wall thickness ≤3 mm without color Doppler signal in all segments. RESULTS From May 2021 to April 2023, 193 patients with left-sided or extensive UC were included. Inflammatory findings on IUS at diagnosis were associated with symptomatic, biochemical, and endoscopic markers of inflammation, but not with diagnostic delay. IUS-detected inflammation at diagnosis was an independent predictor for colectomy within the first 3 months, with bowel wall thickness >6 mm as the optimal cutoff (odds ratio 38, 95% confidence interval, 8-270, P < .0001). Three months after diagnosis, 59% of patients achieved transmural remission, which was associated with higher rates of steroid-free clinical remission in all subsequent follow-ups, as well as a reduced need for steroids during follow-up (6% vs. 19%, P = .036). Furthermore, transmural remission at 3 months increased the likelihood of steroid-free clinical remission, as well as transmural and complete remission, at 12 months. CONCLUSIONS Findings by IUS at the time of diagnosis predict early colectomy risk in UC. Our results underscore that transmural remission is a feasible treatment target in early UC, and significantly impacts the disease course.
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Affiliation(s)
- Gorm Roager Madsen
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Gastrounit, Medical Section, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Rune Wilkens
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Digestive Disease Center, Copenhagen University Hospital - Bispebjerg, Copenhagen, Denmark
| | - Mohamed Attauabi
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Gastrounit, Medical Section, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Gastroenterology and Hepatology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Johan F K F Ilvemark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Gastrounit, Medical Section, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Gastroenterology and Hepatology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Klaus Theede
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Gastrounit, Medical Section, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Jacob Tveiten Bjerrum
- Department of Gastroenterology and Hepatology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Flemming Bendtsen
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Gastrounit, Medical Section, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Benedict Seidelin
- Department of Gastroenterology and Hepatology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Trine Boysen
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Gastrounit, Medical Section, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Johan Burisch
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Gastrounit, Medical Section, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Chaemsupaphan T, Arzivian A, Leong RW. Comprehensive care of ulcerative colitis: new treatment strategies. Expert Rev Gastroenterol Hepatol 2025. [PMID: 39865726 DOI: 10.1080/17474124.2025.2457451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Revised: 01/16/2025] [Accepted: 01/20/2025] [Indexed: 01/28/2025]
Abstract
INTRODUCTION Ulcerative colitis is a chronic inflammatory condition of the colon driven by aberrant immune activation. Although advanced medical therapies form the cornerstone of ulcerative colitis management, unmet needs include failure to induce and sustain remission in a substantial proportion of patients and in managing acute severe ulcerative colitis. We review new treatment strategies that might improve patient outcomes in the management of moderate-to-severe ulcerative colitis. AREAS COVERED A literature search was conducted using the PubMed database, including studies published from inception to October 2024, selected for their relevance. Recognizing current limitations, this article reviews strategies to improve treatment outcomes in ulcerative colitis using advanced therapies. These approaches include early treatment initiation, dose optimization, positioning newer agents as first-line therapies, combination therapy, targeting novel therapeutic endpoints, and the management of acute severe ulcerative colitis. EXPERT OPINION The strategies discussed may contribute to establishing new standards of care aimed at achieving long-term remission and enhancing patient outcomes. Personalized therapy, which tailors treatment based on individual disease characteristics and risk factors, is anticipated to become a critical aspect of delivering more effective care in the future.
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Affiliation(s)
- Thanaboon Chaemsupaphan
- Division of Gastroenterology, Department of Medicine, Siriraj Hospital, Mahidol University, Thailand
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, Australia
| | - Arteen Arzivian
- Department of Gastroenterology and Hepatology, St Vincent's Hospital, Sydney, Australia
| | - Rupert W Leong
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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Centanni L, Cicerone C, Fanizzi F, D’Amico F, Furfaro F, Zilli A, Parigi TL, Peyrin-Biroulet L, Danese S, Allocca M. Advancing Therapeutic Targets in IBD: Emerging Goals and Precision Medicine Approaches. Pharmaceuticals (Basel) 2025; 18:78. [PMID: 39861141 PMCID: PMC11768140 DOI: 10.3390/ph18010078] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2024] [Revised: 01/04/2025] [Accepted: 01/07/2025] [Indexed: 01/27/2025] Open
Abstract
Inflammatory bowel diseases (IBD) including Crohn's disease (CD) and ulcerative colitis (UC) are chronic, relapsing conditions characterized by dysregulated immune responses and persistent intestinal inflammation. This review aims to examine new potential therapeutic targets in IBD starting from the STRIDE-II statements. Key targets now include clinical remission, endoscopic remission, and biomarker normalization (such as C-reactive protein and fecal calprotectin). Moreover, histologic remission, transmural remission, and in the future molecular targets are emerging as important indicators of sustained disease control. The treatment goals for inflammatory bowel disease are varied: to relieve symptoms, prevent permanent intestinal damage, promote inflammation remission, and minimize complications. Consequently, the therapeutic targets have evolved to become broader and more ambitious. Integrating these advanced therapeutic targets has the potential to redefine IBD management by promoting deeper disease control and improved patient outcomes. Further research is essential to validate these strategies and optimize their clinical implementation.
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Affiliation(s)
- Lucia Centanni
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, Italy
| | - Clelia Cicerone
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, Italy
| | - Fabrizio Fanizzi
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, Italy
| | - Ferdinando D’Amico
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, Italy
| | - Federica Furfaro
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, Italy
| | - Alessandra Zilli
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, Italy
| | - Tommaso Lorenzo Parigi
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, INFINY Institute, INSERM NGERE, CHRU de Nancy, Université de Lorraine, F-54500 Vandœuvre-lès-Nancy, France
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, Italy
| | - Mariangela Allocca
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, Italy
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Shankar N, Kuo L, Krugliak Cleveland N, Galen B, Samel NS, Perez-Sanchez A, Nathanson R, Coss E, Echavarria J, Rubin DT, Soni NJ. Point-of-Care Ultrasound in Gastroenterology and Hepatology. Clin Gastroenterol Hepatol 2025:S1542-3565(25)00019-9. [PMID: 39793722 DOI: 10.1016/j.cgh.2024.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 09/17/2024] [Accepted: 09/30/2024] [Indexed: 01/13/2025]
Abstract
Point-of-care ultrasound (POCUS) is changing the practice of nearly all specialties and is increasingly being incorporated as a bedside tool by more gastroenterologists and hepatologists. POCUS is most often used to answer focused diagnostic questions, supplement the traditional physical examination, and guide performance of invasive bedside procedures. This review describes several common POCUS applications used in gastroenterology and hepatology, as well as some novel applications that warrant further investigation.
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Affiliation(s)
- Nagasri Shankar
- Division of Gastroenterology and Hepatology, Joe R. Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Lily Kuo
- Division of Gastroenterology and Hepatology, Joe R. Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | | | - Benjamin Galen
- Division of Hospital Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Nicholas S Samel
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Ariadna Perez-Sanchez
- Division of Hospital Medicine, Joe R. Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Robert Nathanson
- Division of Hospital Medicine, Joe R. Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas; Medicine Service, South Texas Veterans Health Care System, San Antonio, Texas
| | - Elizabeth Coss
- Medicine Service, South Texas Veterans Health Care System, San Antonio, Texas
| | - Juan Echavarria
- Division of Gastroenterology and Hepatology, Joe R. Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - David T Rubin
- University of Chicago Medicine IBD Center, Chicago, Illinois
| | - Nilam J Soni
- Division of Hospital Medicine, Joe R. Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas; Medicine Service, South Texas Veterans Health Care System, San Antonio, Texas; Division of Pulmonary Diseases and Critical Care Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas.
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Herrlinger KR, Stange EF. [New treatment targets for inflammatory bowel disease?]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2025; 66:55-63. [PMID: 39714486 DOI: 10.1007/s00108-024-01826-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/27/2024] [Indexed: 12/24/2024]
Abstract
The classic therapeutic goals of chronic inflammatory bowel disease (IBD) are, on the one hand, clinical remission and, on the other, the prevention of disease progression. The introduction of additional "targets" such as normalization of laboratory inflammation values, endoscopic and, possibly, histological mucosal healing and transmural parameters (ultrasound, magnetic resonance imaging and computed tomography) is intended to improve prognosis. A good response to therapy is usually (also) evident from these targets, although the obligatory change in medication in order to improve the prognosis if the additional treatment goals are not achieved is not evidence-based. In the case of Crohn's disease and ulcerative colitis, individual and, if possible, personalized medicine should continue to be provided instead of strict target specifications.
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Affiliation(s)
| | - E F Stange
- Innere Medizin I, Universitätsklinikum Tübingen, Otfried-Müller-Straße 10, 72076, Tübingen, Deutschland.
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Bertin L, Nasrallah M, Redavid C, Bonazzi E, Maniero D, Lorenzon G, De Barba C, Facchin S, Scarpa M, Ruffolo C, Angriman I, Buda A, Fassan M, Lacognata C, Barberio B, Zingone F, Savarino EV. Risk Factors and Postoperative Outcomes in Pouchitis Following Restorative Proctocolectomy: An 18-Year Single-Center Study. GASTROENTEROLOGY INSIGHTS 2024; 15:1075-1092. [DOI: 10.3390/gastroent15040074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2025] Open
Abstract
Background/Objectives: Restorative proctocolectomy with ileo-anal pouch anastomosis (IPAA) remains the preferred surgical treatment for ulcerative colitis (UC). However, complications like pouchitis can occur. This study aimed to describe patients who underwent IPAA for inflammatory bowel disease (IBD) at Padua Hospital from 2005 to 2023 and identify risk factors for pouchitis. Secondary objectives included evaluating the effectiveness of biological therapy in chronic antibiotic-refractory pouchitis (CARP), Crohn’s disease of the pouch (CDP), and Crohn’s-like inflammation of the pouch (CDLPI), and assessing risk factors for pouch failure. Methods: This retrospective, observational study included 109 patients whose data were collected from medical records. Univariate logistic regression was used to analyze associations between preoperative and postoperative factors and outcomes such as acute pouchitis and pouch failure. The effectiveness of biological therapy was assessed by measuring changes in the Pouchitis Disease Activity Index (PDAI) and the Modified Pouchitis Disease Activity Index (mPDAI) over a 12-month treatment period. Results: Univariate logistic regression revealed significant associations between preoperative extraintestinal manifestations (OR 3.569, 95% CI 1.240–10.720), previous diagnosis of Crohn’s disease (OR 10.675, 95% CI 1.265–90.089), and transmural inflammation at cross-sectional imaging before surgery (OR 3.453, 95% CI 1.193–9.991) with an acute pouchitis risk. Pouch failure was significantly associated with a previous diagnosis of Crohn’s disease (OR 9.500, 95% CI 1.821–49.571) and post-surgical fistulas (OR 41.597, 95% CI 4.022–430.172). Biological therapy led to a significant reduction in the PDAI score in patients with CARP, decreasing from a median of 10 to 4 (p = 0.006). Similarly, in patients with CDP or CDLPI, the mPDAI score was significantly reduced from a median of 9 to 1 (p = 0.034), with remission achieved in 5/6 (83.3%) of these patients. Conclusions: This study provides valuable insights into the management of IPAA patients and highlights the importance of early identification and treatment of risk factors for pouchitis and failure. Biological therapy demonstrated significant effectiveness in reducing disease activity in patients with CARP, CDP, and CDLPI, suggesting its role as a crucial component in managing these complications.
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Affiliation(s)
- Luisa Bertin
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35122 Padua, Italy
- Gastroenterology Unit, Azienda Ospedale—Università Padova, 35128 Padua, Italy
| | - Mohamad Nasrallah
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35122 Padua, Italy
| | - Carlo Redavid
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35122 Padua, Italy
| | - Erica Bonazzi
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35122 Padua, Italy
| | - Daria Maniero
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35122 Padua, Italy
| | - Greta Lorenzon
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35122 Padua, Italy
| | - Caterina De Barba
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35122 Padua, Italy
| | - Sonia Facchin
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35122 Padua, Italy
| | - Marco Scarpa
- Chirurgia Generale 3 Unit, Azienda Ospedale Università di Padova, Via Giustiniani 2, 35128 Padua, Italy
| | - Cesare Ruffolo
- Chirurgia Generale 3 Unit, Azienda Ospedale Università di Padova, Via Giustiniani 2, 35128 Padua, Italy
| | - Imerio Angriman
- Chirurgia Generale 3 Unit, Azienda Ospedale Università di Padova, Via Giustiniani 2, 35128 Padua, Italy
| | - Andrea Buda
- Gastroenterology Unit, Department of Oncological Gastrointestinal Surgery, S. Maria del Prato Hospital, 32032 Feltre, Italy
| | - Matteo Fassan
- Veneto Institute of Oncology IOV—Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), 35128 Padova, Italy
- Department of Medicine, University of Padova, 35122 Padova, Italy
| | | | - Brigida Barberio
- Gastroenterology Unit, Azienda Ospedale—Università Padova, 35128 Padua, Italy
| | - Fabiana Zingone
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35122 Padua, Italy
- Gastroenterology Unit, Azienda Ospedale—Università Padova, 35128 Padua, Italy
| | - Edoardo Vincenzo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35122 Padua, Italy
- Gastroenterology Unit, Azienda Ospedale—Università Padova, 35128 Padua, Italy
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11
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Zhu F, Chen X, Qiu X, Guo W, Wang X, Cao J, Gong J. Seeing Beyond the Surface: Superior Performance of Ultrasound Elastography over Milan Ultrasound Criteria in Distinguishing Fibrosis of Ulcerative Colitis. J Crohns Colitis 2024; 18:1795-1803. [PMID: 38828738 DOI: 10.1093/ecco-jcc/jjae081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/03/2024] [Accepted: 06/02/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Colonic fibrosis has important clinical implications in ulcerative colitis [UC]. Ultrasound imaging has emerged as a convenient and reliable tool in diagnosis of inflammatory bowel disease. We aimed to explore the potential use of ultrasound to evaluate UC fibrosis. METHODS Consecutive UC patients who had proctocolectomy from July 2022 to September 2023 were enrolled in the study. Patients underwent bowel ultrasound examination and ultrasound elastography imaging prior to surgery. Milan ultrasound criteria [MUC] were calculated and bowel wall stiffness was determined using two mean strain ratios [MSRs]. Degree of colonic fibrosis and inflammation was measured upon histological analysis. Receiver operating characteristic [ROC] analysis was used to evaluate the performance of ultrasound-derived parameters to predict fibrosis. RESULTS In all, 56 patients were enrolled with 112 segments included in analysis. The median fibrosis score was 2 [0-4] and the median Geboes score was 5 [0-13] and these two scores were significantly correlated [p < 0.001]. The muscularis mucosa thickness was significantly higher in moderate-severe fibrosis than none-mild fibrosis [p = 0.003] but bowel wall thickness was not [p = 0.082]. The strain ratios [p < 0.001] and MUC [p = 0.010] were significantly higher in involved than non-involved segments. The strain ratios were correlated with fibrosis score [p < 0.001] but not MUC [p = 0.387]. At ROC analysis, mean strain ratio 1 [MSR1] had an area under the curve [AUC] of 0.828 [cutoff value 3.07, 95% CI 0.746-0.893, p < 0.001] to predict moderate-severe fibrosis. CONCLUSION Ultrasound elastography imaging could predict the degree of colonic fibrosis in UC. Application of this technique could help disease monitoring and decision making in UC patients.
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Affiliation(s)
- Feng Zhu
- Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, PR.China
| | - Xin Chen
- Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, PR.China
| | - Xueni Qiu
- Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, PR.China
| | - Wenwen Guo
- Department of Pathology, Second Hospital affiliated to Nanjing Medical University, Nanjing, PR.China
| | - Xuesong Wang
- Department of Ultrasound Diagnosis, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, PR.China
| | - Junying Cao
- Department of Ultrasound Diagnosis, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, PR.China
| | - Jianfeng Gong
- Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, PR.China
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12
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Pal P, Mateen MA, Pooja K, Rajadurai N, Gupta R, Tandan M, Duvvuru NR. Role of intestinal ultrasound in ulcerative colitis: A systematic review. World J Meta-Anal 2024; 12:97210. [DOI: 10.13105/wjma.v12.i3.97210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 08/07/2024] [Accepted: 08/14/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Intestinal ultrasound (IUS) is an emerging, non-invasive, and highly sensitive diagnostic tool in inflammatory bowel disease (IBD), including ulcerative colitis (UC). Despite its potential, its adoption in clinical practice is limited due to a lack of standardization and awareness.
AIM To perform a comprehensive scoping review based on a systematic literature review on IUS in UC to inform current practice.
METHODS Ninety-nine original articles about ultrasonography in UC were identified among 7608 citations searching PubMed and EMBASE databases for systematic review.
RESULTS IUS can be useful as an initial diagnostic strategy in patients with suspected IBD/UC. In UC, IUS can predict endoscopic response, histologic healing, and steroid responsiveness in acute severe cases. IUS can predict response to biologics/small molecules (as early as 2 wk). IUS correlates well with ileo-colonoscopy, but IUS could miss rectal, jejunal, and upper GI lesions in suspected IBD and colon polyps or extra-intestinal manifestations in known IBD. IUS is useful in special situations (children, pregnancy, and postoperative Crohn's disease). Inter-observer agreement is acceptable and trained physicians have comparable diagnostic accuracy. Point-of-care ultrasound impacted management in 40%-60% of cases. Hand-held IUS has excellent agreement with conventional IUS.
CONCLUSION IUS is a non-invasive, highly sensitive tool in the diagnosis and monitoring of UC, offering excellent patient satisfaction. Point-of-care ultrasound by IBD physicians can significantly impact clinical decision-making.
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Affiliation(s)
- Partha Pal
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, India
| | - Mohammad Abdul Mateen
- Department of Diagnostic Radiology and Imaging, Asian Institute of Gastroenterology, Hyderabad 500082, India
| | - Kanapuram Pooja
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, India
| | - Nandhakumar Rajadurai
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, India
| | - Rajesh Gupta
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, India
| | - Manu Tandan
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, India
| | - Nageshwar Reddy Duvvuru
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, India
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13
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Herrlinger KR, Stange EF. To STRIDE or not to STRIDE: a critique of "treat to target" in ulcerative colitis. Expert Rev Gastroenterol Hepatol 2024; 18:493-504. [PMID: 39193775 DOI: 10.1080/17474124.2024.2397654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 08/24/2024] [Indexed: 08/29/2024]
Abstract
INTRODUCTION The STRIDE consensus intends to complement the clinical endpoint with an endoscopic endpoint of mucosal healing and others as treatment targets in ulcerative colitis. If these targets are not reached, STRIDE requires dose or timing adjustments or switching the medication. This narrative review provides a critique of this concept. AREAS COVERED We analyze and discuss the limitations of current endpoints as targets, their currently limited achievability, and the lacking evidence from controlled trials relating to 'treat to target.' The relevant publications in PubMed were identified in a literature review with the key word 'ulcerative colitis.' EXPERT OPINION In ulcerative colitis, the standard clinical target is measured traditionally by the MAYO-score, but in variable combinations of patient and physician reported outcomes as well as also different definitions of the endoscopic part. Only a score of 0 is more stringent than clinical remission but is only achieved by a minority of patients in first and even less in second line therapy. The concept is not based on clear evidence that patients indeed benefit from appropriate escalation of treatment. Until the STRIDE approach is proven to be superior to standard treatment focusing on clinical well-being, the field should remain reluctant.
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Affiliation(s)
| | - Eduard F Stange
- Innere Medizin I, UniversitätsklinikTübingen, Tübingen, Germany
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14
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Dal Buono A, Armuzzi A. Transperineal Ultrasonography in the Assessment of Rectal Inflammation: Beyond the Monitoring of Ulcerative Colitis. Inflamm Bowel Dis 2024; 30:1437-1438. [PMID: 37863022 DOI: 10.1093/ibd/izad254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Arianna Dal Buono
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Alessandro Armuzzi
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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15
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Tran F, Scharmacher A, Baran N, Mishra N, Wozny M, Chavez SP, Bhardwaj A, Hinz S, Juzenas S, Bernardes JP, Sievers LK, Lessing M, Aden K, Lassen A, Bergfeld A, Weber HJ, Neas L, Vetrano S, Schreiber S, Rosenstiel P. Dynamic changes in extracellular vesicle-associated miRNAs elicited by ultrasound in inflammatory bowel disease patients. Sci Rep 2024; 14:10925. [PMID: 38740826 DOI: 10.1038/s41598-024-61532-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024] Open
Abstract
Blood-based biomarkers that reliably indicate disease activity in the intestinal tract are an important unmet need in the management of patients with IBD. Extracellular vesicles (EVs) are cell-derived membranous microparticles, which reflect the cellular and functional state of their site of site of origin. As ultrasound waves may lead to molecular shifts of EV contents, we hypothesized that application of ultrasound waves on inflamed intestinal tissue in IBD may amplify the inflammation-specific molecular shifts in EVs like altered EV-miRNA expression, which in turn can be detected in the peripheral blood. 26 patients with IBD were included in the prospective clinical study. Serum samples were collected before and 30 min after diagnostic transabdominal ultrasound. Differential miRNA expression was analyzed by sequencing. Candidate inducible EV-miRNAs were functionally assessed in vitro by transfection of miRNA mimics and qPCR of predicted target genes. Serum EV-miRNA concentration at baseline correlated with disease severity, as determined by clinical activity scores and sonographic findings. Three miRNAs (miR-942-5p, mir-5588, mir-3195) were significantly induced by sonography. Among the significantly regulated EV-miRNAs, miR-942-5p was strongly induced in higher grade intestinal inflammation and correlated with clinical activity in Crohn's disease. Prediction of target regulation and transfection of miRNA mimics inferred a role of this EV-miRNA in regulating barrier function in inflammation. Induction of mir-5588 and mir-3195 did not correlate with inflammation grade. This proof-of-concept trial highlights the principle of induced molecular shifts in EVs from inflamed tissue through transabdominal ultrasound. These inducible EVs and their molecular cargo like miRNA could become novel biomarkers for intestinal inflammation in IBD.
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Affiliation(s)
- Florian Tran
- Institute of Clinical Molecular Biology, University Medical Center Schleswig-Holstein, Christian Albrecht University Kiel, Campus Kiel, Rosalind-Franklin-Strasse 12, 24105, Kiel, Germany.
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, 24105, Kiel, Germany.
| | - Alena Scharmacher
- Institute of Clinical Molecular Biology, University Medical Center Schleswig-Holstein, Christian Albrecht University Kiel, Campus Kiel, Rosalind-Franklin-Strasse 12, 24105, Kiel, Germany
| | - Nathan Baran
- Institute of Clinical Molecular Biology, University Medical Center Schleswig-Holstein, Christian Albrecht University Kiel, Campus Kiel, Rosalind-Franklin-Strasse 12, 24105, Kiel, Germany
| | - Neha Mishra
- Institute of Clinical Molecular Biology, University Medical Center Schleswig-Holstein, Christian Albrecht University Kiel, Campus Kiel, Rosalind-Franklin-Strasse 12, 24105, Kiel, Germany
| | - Marek Wozny
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Italy
| | - Samuel Pineda Chavez
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Italy
| | - Archana Bhardwaj
- Institute of Clinical Molecular Biology, University Medical Center Schleswig-Holstein, Christian Albrecht University Kiel, Campus Kiel, Rosalind-Franklin-Strasse 12, 24105, Kiel, Germany
| | - Sophia Hinz
- Institute of Clinical Molecular Biology, University Medical Center Schleswig-Holstein, Christian Albrecht University Kiel, Campus Kiel, Rosalind-Franklin-Strasse 12, 24105, Kiel, Germany
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, 24105, Kiel, Germany
| | - Simonas Juzenas
- Institute of Clinical Molecular Biology, University Medical Center Schleswig-Holstein, Christian Albrecht University Kiel, Campus Kiel, Rosalind-Franklin-Strasse 12, 24105, Kiel, Germany
- Institute of Biotechnology, Life Science Centre, Vilnius University, Vilnius, Lithuania
| | - Joana P Bernardes
- Institute of Clinical Molecular Biology, University Medical Center Schleswig-Holstein, Christian Albrecht University Kiel, Campus Kiel, Rosalind-Franklin-Strasse 12, 24105, Kiel, Germany
| | - Laura Katharina Sievers
- Institute of Clinical Molecular Biology, University Medical Center Schleswig-Holstein, Christian Albrecht University Kiel, Campus Kiel, Rosalind-Franklin-Strasse 12, 24105, Kiel, Germany
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, 24105, Kiel, Germany
| | - Matthias Lessing
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, 24105, Kiel, Germany
| | - Konrad Aden
- Institute of Clinical Molecular Biology, University Medical Center Schleswig-Holstein, Christian Albrecht University Kiel, Campus Kiel, Rosalind-Franklin-Strasse 12, 24105, Kiel, Germany
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, 24105, Kiel, Germany
| | - Arne Lassen
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, 24105, Kiel, Germany
| | - Arne Bergfeld
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, 24105, Kiel, Germany
| | - Hauke Jann Weber
- Department of Gastroenterology, Asklepios Westklinikum, 22559, Hamburg, Germany
- Institute of Infection Medicine, University Medical Center Schleswig-Holstein, Christian Albrecht University Kiel, 24105, Kiel, Germany
| | - Lennart Neas
- Department of Internal Medicine III, University Medical Center Schleswig-Holstein, 24105, Kiel, Germany
| | - Stefania Vetrano
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Italy
- IBD Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089, Rozzano, Italy
| | - Stefan Schreiber
- Institute of Clinical Molecular Biology, University Medical Center Schleswig-Holstein, Christian Albrecht University Kiel, Campus Kiel, Rosalind-Franklin-Strasse 12, 24105, Kiel, Germany
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, 24105, Kiel, Germany
| | - Philip Rosenstiel
- Institute of Clinical Molecular Biology, University Medical Center Schleswig-Holstein, Christian Albrecht University Kiel, Campus Kiel, Rosalind-Franklin-Strasse 12, 24105, Kiel, Germany
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16
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Mihai VC, Gheorghe L, Rezuș II, Jucan AE, Andronic MC, Gavrilescu O, Dranga M, Andronic AM, Prelipcean CC, Rezuș C, Mihai C. Novelties and Perspectives of Intestinal Ultrasound in the Personalised Management of Patients with Inflammatory Bowel Diseases-A Systematic Review. Diagnostics (Basel) 2024; 14:812. [PMID: 38667458 PMCID: PMC11049436 DOI: 10.3390/diagnostics14080812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 03/29/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Inflammatory bowel diseases (IBDs) affect over 4.9 million individuals worldwide. Colonoscopy (CS) is the gold-standard technique for diagnosis. The remissive-recurrent pattern of evolution raises the need for non-invasive techniques to monitor disease activity. This review aims to present the advantages of intestinal ultrasound (IUS) in managing IBDs. Our search was conducted on the PubMed, Embase, and Cochrane (CENTRAL) databases, selecting original studies comparing IUS with other imaging and invasive monitoring methods. Our search yielded 8654 results, of which 107 met the inclusion criteria. Increased bowel wall thickness (BWT) and colour Doppler signal (CDS) are discriminative for disease activity. IUS can predict disease outcomes and detect response to treatment or postoperative recurrence. Contrast-enhanced ultrasound (CEUS) and elastography help differentiate fibrotic from inflammatory stenoses. The difficult rectal assessment limits the use of IUS in ulcerative colitis (UC). Transmural healing may develop as a therapeutic target as it is associated with better outcomes. Patients are compliant with this technique, and its results correlate well with CS and other imaging methods. In conclusion, IUS proves to be essential in assessing IBD activity and treatment response, predicting outcomes and detecting complications. CEUS and elastography are researched to improve the diagnostic values of IUS.
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Affiliation(s)
- Vasile-Claudiu Mihai
- Department of Radiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Radiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania
| | - Liliana Gheorghe
- Department of Radiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Radiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania
| | - Ioana-Irina Rezuș
- Department of Radiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Radiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania
| | - Alina Ecaterina Jucan
- Discipline of Gastroenterology, Medical Department I, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.E.J.); (M.-C.A.); (O.G.); (M.D.); (C.M.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania;
| | - Mihaela-Cristiana Andronic
- Discipline of Gastroenterology, Medical Department I, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.E.J.); (M.-C.A.); (O.G.); (M.D.); (C.M.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania;
| | - Otilia Gavrilescu
- Discipline of Gastroenterology, Medical Department I, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.E.J.); (M.-C.A.); (O.G.); (M.D.); (C.M.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania;
| | - Mihaela Dranga
- Discipline of Gastroenterology, Medical Department I, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.E.J.); (M.-C.A.); (O.G.); (M.D.); (C.M.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania;
| | - Andrei-Mihai Andronic
- Discipline of Medical Semiology, Medical Department I, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Cristina Cijevschi Prelipcean
- Institute of Gastroenterology and Hepatology, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania;
| | - Ciprian Rezuș
- Discipline of Internal Medicine, Medical Department I, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
- 3rd Internal Medicine Clinic, “Sf. Spiridon” Emergency County Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania
| | - Cătălina Mihai
- Discipline of Gastroenterology, Medical Department I, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.E.J.); (M.-C.A.); (O.G.); (M.D.); (C.M.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania;
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17
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Tagliamonte G, Santagata F, Fraquelli M. Current Developments and Role of Intestinal Ultrasound including the Advent of AI. Diagnostics (Basel) 2024; 14:759. [PMID: 38611672 PMCID: PMC11011653 DOI: 10.3390/diagnostics14070759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Intestinal ultrasound is a non-invasive, safe, and cost-effective technique to study the small and large intestines. In addition to conventional B-mode and color doppler imaging, new US tools have been developed in more recent years that provide auxiliary data on many GI conditions, improving the diagnosis and assessment of relevant outcomes. We have reviewed the more recent literature (from 2010 onwards) on auxiliary tools in bowel ultrasound such as elastography techniques, CEUS, SICUS, and the potential contribution by artificial intelligence (AI) to overcome current intestinal ultrasound limitations. For this scoping review, we performed an extensive literature search on PubMed and EMBASE to identify studies published until December 2023 and investigating the application of elastography techniques, CEUS, SICUS, and AI in the ultrasonographic assessment of the small and large intestines. Multiparametric intestinal ultrasound shows promising capabilities in Crohn's disease, while less is known about the role in ulcerative colitis. Despite some evidence, the CEUS role as a point-of-care examination tool for rare conditions such as intestinal GvHD and ischemic small bowel disease seems promising, possibly avoiding the need to perform further cross-sectional imaging. The use of AI in intestinal ultrasound is still anecdotical and limited to acute appendicitis.
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Affiliation(s)
- Gennaro Tagliamonte
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy; (G.T.); (F.S.)
| | - Fabrizio Santagata
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy; (G.T.); (F.S.)
| | - Mirella Fraquelli
- Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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18
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Piazza O Sed N, Noviello D, Filippi E, Conforti F, Furfaro F, Fraquelli M, Costantino A, Danese S, Vecchi M, Fiorino G, Allocca M, Caprioli F. Superior predictive value of transmural over endoscopic severity for colectomy risk in ulcerative colitis: a multicentre prospective cohort study. J Crohns Colitis 2024; 18:291-299. [PMID: 37632350 PMCID: PMC10896635 DOI: 10.1093/ecco-jcc/jjad152] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND AND AIMS Endoscopic activity is associated with an increased risk of surgery in patients with ulcerative colitis [UC]. Transmural activity, as defined by Milan Ultrasound Criteria [MUC] > 6.2, reliably detects endoscopic activity in patients with UC. The present study aimed to assess in UC patients whether transmural severity is a better predictor of colectomy as compared to endoscopy. METHODS Consecutive adult UC patients were recruited in two IBD Referral Centres and underwent colonoscopy and intestinal ultrasound in a blinded fashion. The need for colectomy was assessed at follow-up. Univariable and multivariable logistic and Cox regression analyses were performed. Receiver operating characteristic [ROC] analysis was used to compare MUC baseline values and Mayo Endoscopic Scores [MES] in predicting colectomy risk. RESULTS Overall, 141 patients were enrolled, and 13 underwent colectomy in the follow-up period. Both MES (hazard ratio [HR]: 3.15, 95% confidence interval [CI]: 1.18-8.37, p = 0.02) and MUC [HR: 1.48, 95% CI: 1.19-1.76, p < 0.001] were associated with colectomy risk, but only MUC was independently associated with this event on multivariable analysis [HR: 1.46, 95% CI: 1.06-2.02, p = 0.02]. MUC was the only independent variable associated with colectomy risk in patients with clinically active disease (odds ratio [OR]: 1.53 [1.03-2.27], p = 0.03). MUC demonstrated higher accuracy than MES (area under ROC curve [AUROC] 0.83, 95% CI: 0.75-0.92 vs 0.71, 95% CI: 0.62-0.80) and better performance for predicting colectomy [p = 0.02]. The optimal MUC score cut-off value for predicting colectomy, as assessed by the Youden index, was 7.7. CONCLUSIONS A superior predictive value was found for transmural vs endoscopic severity for colectomy risk in UC patients.
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Affiliation(s)
- Nicole Piazza O Sed
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Noviello
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Elisabetta Filippi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Francesco Conforti
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Furfaro
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele Milano, Milan, Italy
| | - Mirella Fraquelli
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Costantino
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele Milano, Milan, Italy
- University Vita-Salute San Raffaele Milano, Milan, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gionata Fiorino
- University Vita-Salute San Raffaele Milano, Milan, Italy
- IBD Unit, Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, Rome, Italy
| | - Mariangela Allocca
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele Milano, Milan, Italy
| | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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19
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Vitello A, Maida M, Shahini E, Macaluso FS, Orlando A, Grova M, Ramai D, Serviddio G, Facciorusso A. Current Approaches for Monitoring of Patients with Inflammatory Bowel Diseases: A Narrative Review. J Clin Med 2024; 13:1008. [PMID: 38398321 PMCID: PMC10888591 DOI: 10.3390/jcm13041008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Patients with inflammatory bowel diseases (IBD) require proactive monitoring both during the active phase to evaluate therapeutic response and during the remission phase to evaluate relapse or colorectal cancer surveillance. However, monitoring may vary between patients with ulcerative colitis (UC) and Crohn's disease (CD), with distinct tools and intervals. METHODS This narrative review aims to focus on modern approaches to IBD monitoring, considering international guidelines and expert consensus. RESULTS The most recent European diagnostic guidelines advocate a combination of clinical, laboratory, endoscopic, and radiological parameters to evaluate the disease course of patients with IBD. Unfortunately, the conventional symptom-based therapeutic approach does not improve long-term outcomes and there is no single ideal biomarker available. Endoscopy plays a key role in evaluating response to therapy as well as monitoring disease activity. Recently, bedside intestinal ultrasound (IUS) has gained increasing interest and diffusion as it appears to offer several advantages including the monitoring of therapeutic response. CONCLUSION In light of growing clinical advances, we present a schematic evidence-based monitoring algorithm that can be easily applied in clinical practice which combines all major monitoring modalities, including noninvasive tools such as IUS and video-capsule endoscopy.
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Affiliation(s)
- Alessandro Vitello
- Gastroenterology and Endoscopy Unit, S. Elia Hospital, 93100 Caltanissetta, Italy; (A.V.); (M.M.)
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia Hospital, 93100 Caltanissetta, Italy; (A.V.); (M.M.)
- Department of Medicine and Surgery, School of Medicine and Surgery, University of Enna ‘Kore’, 94100 Enna, Italy
| | - Endrit Shahini
- Gastroenterology Unit, National Institute of Gastroenterology-IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy;
| | - Fabio Salvatore Macaluso
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. “Villa Sofia-Cervello” Hospital, 90146 Palermo, Italy; (F.S.M.); (A.O.); (M.G.)
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. “Villa Sofia-Cervello” Hospital, 90146 Palermo, Italy; (F.S.M.); (A.O.); (M.G.)
| | - Mauro Grova
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. “Villa Sofia-Cervello” Hospital, 90146 Palermo, Italy; (F.S.M.); (A.O.); (M.G.)
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT 84132, USA;
| | - Gaetano Serviddio
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy;
| | - Antonio Facciorusso
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy;
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20
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Barchi A, Dal Buono A, D’Amico F, Furfaro F, Zilli A, Fiorino G, Parigi TL, Peyrin-Biroulet L, Danese S, Allocca M. Leaving behind the Mucosa: Advances and Future Directions of Intestinal Ultrasound in Ulcerative Colitis. J Clin Med 2023; 12:7569. [PMID: 38137644 PMCID: PMC10744120 DOI: 10.3390/jcm12247569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/27/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Inflammatory Bowel Diseases (IBD), mainly Ulcerative Colitis (UC) and Crohn's Disease (CD), are disorders characterized by chronic inflammation with severe morbidity and long-term disabling quality of life outcomes. UC mainly affects the mucosal and sub-mucosal layers of the colon, without embracing the peri-intestinal structures. Considering the predominant mucosal location of UC inflammation, the implementation of transmural evaluation by cross-sectional imaging techniques, mainly Intestinal Ultrasound (IUS), has been left behind for ages, especially if compared to CD. Nevertheless, studies analyzing intestinal ultrasound parameters accuracy in disease activity detection reported a good-to-optimal correlation of IUS markers with colonic inflammation, suggesting comparable feasibility of IUS monitoring in UC as in CD. The easy-to-use, costless and point-of-care available status of IUS is therefore crucial in order to improve the diagnostic process and, according to the recent literature, to monitor the response to treatment leading to speeding up decision making and therapy adjustments. Recent studies have demonstrated the correlation between transmural healing in UC with favorable outcomes even in the long term. An evidence gap still exists in the assessment of the rectum, with trans-perineal ultrasound (TPUS) a potential answer to reach a more precise evaluation of rectal inflammation. Eventually, IUS is also increasingly showing promises in emergent or post-surgical UC settings, considering various efforts put in line to demonstrate its feasibility in predicting response to salvage therapy for surgery avoidance and in studying inflammation relapse after procto-colectomy with ileo-pouch-anal anastomosis (IPAA) creation.
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Affiliation(s)
- Alberto Barchi
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.B.); (F.D.); (F.F.); (A.Z.); (G.F.); (S.D.)
| | - Arianna Dal Buono
- IBD Center, Humanitas Research Hospital-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Ferdinando D’Amico
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.B.); (F.D.); (F.F.); (A.Z.); (G.F.); (S.D.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Federica Furfaro
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.B.); (F.D.); (F.F.); (A.Z.); (G.F.); (S.D.)
| | - Alessandra Zilli
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.B.); (F.D.); (F.F.); (A.Z.); (G.F.); (S.D.)
| | - Gionata Fiorino
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.B.); (F.D.); (F.F.); (A.Z.); (G.F.); (S.D.)
| | - Tommaso Lorenzo Parigi
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.B.); (F.D.); (F.F.); (A.Z.); (G.F.); (S.D.)
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, 54500 Vandoeuvre-lès-Nancy, France;
- Department of Gastroenterology, Nancy University Hospital, 54500 Vandœuvre-lès-Nancy, France
- INFINY Institute, Nancy University Hospital, 54500 Vandœuvre-lès-Nancy, France
- Federation Hospitalo-Univeristaire-CURE, Nancy University Hospital, 54500 Vandœuvre-lès-Nancy, France
- Groupe Hospitalier Privé Ambroise Paré-Hartmann, Paris IBD Center, 92200 Neuilly-sur-Seine, France
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.B.); (F.D.); (F.F.); (A.Z.); (G.F.); (S.D.)
| | - Mariangela Allocca
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.B.); (F.D.); (F.F.); (A.Z.); (G.F.); (S.D.)
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21
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Maeda M, Sagami S, Tashima M, Yamana Y, Karashima R, Miyatani Y, Hojo A, Nakano M, Hibi T, Kobayashi T. Milan Ultrasound Criteria Predict Relapse of Ulcerative Colitis in Remission. Inflamm Intest Dis 2023; 8:95-104. [PMID: 38098495 PMCID: PMC10718580 DOI: 10.1159/000532052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/03/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction Bowel ultrasound is a noninvasive alternative to endoscopy for assessing the disease activity of ulcerative colitis; however, it is unclear whether bowel ultrasound can predict subsequent relapse from remission. Materials and Methods A retrospective cohort study enrolled patients with ulcerative colitis who underwent bowel ultrasound between July 2018 and July 2021 during clinical remission (patient-reported outcome-2 ≤1 and no rectal bleeding) for at least 3 months and were followed up for 1 year. Ultrasonographic findings (bowel wall thickness, bowel wall flow, bowel wall stratification, and enlarged lymph nodes), Milan ultrasound criteria, Mayo endoscopic subscore, C-reactive protein, and fecal calprotectin levels and their association with subsequent clinical relapse were assessed. Relapse was defined as rectal bleeding score ≥1, stool frequency score ≥2, or treatment intensification for symptoms. Results 31% of the patients (18/58) relapsed within 1 year. No single ultrasonographic finding predicted relapse, whereas Milan ultrasound criteria >6.2 (p = 0.019), Mayo endoscopic subscore ≥1 (p = 0.013), and fecal calprotectin ≥250 μg/g (p = 0.040) were associated with a shorter time to relapse in the log-rank test. Milan ultrasound criteria >6.2 (hazard ratio 3.22; 95% confidence interval 1.14-9.08, p = 0.027) and Mayo endoscopic subscore ≥1 (hazard ratio 8.70; 95% confidence interval 1.11-68.1, p = 0.039) showed a higher risk of relapse according to a Cox proportional hazards model. Conclusion Bowel ultrasound can predict subsequent clinical relapse from remission in patients with ulcerative colitis using the Milan ultrasound criteria.
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Affiliation(s)
- Masa Maeda
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Shintaro Sagami
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
- Department of Gastroenterology and Hepatology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Moyu Tashima
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Yoko Yamana
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Ryo Karashima
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
- Department of Gastroenterology and Hepatology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Yusuke Miyatani
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Aya Hojo
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
- Department of Gastroenterology and Hepatology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Masaru Nakano
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
- Department of Gastroenterology and Hepatology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
- Department of Gastroenterology and Hepatology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
- Department of Gastroenterology, Kitasato University School of Medicine, Kanagawa, Japan
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22
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Allocca M, Dell'Avalle C, Furfaro F, Zilli A, D'Amico F, Peyrin-Biroulet L, Fiorino G, Danese S. Early Intestinal Ultrasound Predicts Long-Term Endoscopic Response to Biologics in Ulcerative Colitis. J Crohns Colitis 2023; 17:1579-1586. [PMID: 37084137 DOI: 10.1093/ecco-jcc/jjad071] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Indexed: 04/22/2023]
Abstract
BACKGROUND AND AIMS The Milan ultrasound criteria [MUC] is a validated score to assess endoscopic activity in ulcerative colitis [UC]. MUC > 6.2 detects Mayo endoscopic score [MES] > 1. In this study we evaluated the predictive value of MUC for biologic treatment response, using colonoscopy [CS] as a reference standard. METHODS Consecutive UC patients starting biologic therapy were included, and underwent CS, IUS, clinical assessment and faecal calprotectin [FC] measurement at baseline and within 1 year. In addition, IUS, clinical and FC assessments were performed at week 12. The primary objective was to evaluate whether ultrasound improvement [MUC ≤ 6.2] at week 12 predicted endoscopic improvement at reassessment [MES ≤ 1]. Endoscopic remission was defined as MES = 0. RESULTS Forty-nine patients were included [59% under infliximab, 29% under vedolizumab, 8% under adalimumab, 4% under ustekinumab]. MUC ≤ 6.2 at week 12 was the only independent predictor for MES ≤ 1 and MES = 0 at reassessment (odds ratio [OR] 5.80, p = 0.010; OR 10.41, p = 0.041; respectively). MUC ≤ 6.2 at week 12 showed a negative predictive value of 96% for detecting MES = 0. A ≥2 reduction of the MUC predicted MES = 0 (area under the curve [AUC] 0.816). MUC ≤ 4.3 was the most accurate cut-off value for MES = 0 [AUC 0.876]. Guyatt's responsiveness ratio for the MUC was 1.73 [>0.8]. CONCLUSION MUC ≤ 6.2 at week 12 predicts long-term endoscopic response. MUC is accurate in monitoring treatment response and may be used in both clinical trials and routine practice.
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Affiliation(s)
- Mariangela Allocca
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Cecilia Dell'Avalle
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Federica Furfaro
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Alessandra Zilli
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Ferdinando D'Amico
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Division of Colon and Rectal Surgery, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE 1256, University Hospital of Nancy, University of Lorraine, Nancy, France
- Groupe Hospitalier privé Ambroise Paré - Hartmann, Paris IBD center, 92200 Neuilly sur Seine, France
| | - Gionata Fiorino
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
- Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, Rome, Italy
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
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23
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Dolinger MT, Kayal M. Intestinal ultrasound as a non-invasive tool to monitor inflammatory bowel disease activity and guide clinical decision making. World J Gastroenterol 2023; 29:2272-2282. [PMID: 37124889 PMCID: PMC10134421 DOI: 10.3748/wjg.v29.i15.2272] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/19/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023] Open
Abstract
Intestinal ultrasound (IUS) is a non-invasive, real-time, cross-sectional imaging tool that can be used at the point-of-care to assess disease activity in patients with Crohn’s disease or ulcerative colitis. IUS promotes quick and impactful treatment decisions that can modify disease progression and enhance patient compliance. This review will summarize the technical aspects of IUS, the evidence to support the use of IUS in disease activity monitoring, the comparison of IUS to current standard of care monitoring modalities such as colonoscopy and calprotectin, and the optimal positioning of IUS in a tight-control monitoring strategy.
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Affiliation(s)
- Michael T Dolinger
- Department of Pediatric Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Maia Kayal
- Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
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24
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Cleveland NK, Picker EA, Dolinger MT, Rubin DT. The Arrival of Intestinal Ultrasound for Inflammatory Bowel Disease Care in the United States. Gastroenterol Hepatol (N Y) 2023; 19:147-154. [PMID: 37706105 PMCID: PMC10496276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Intestinal ultrasound (IUS) is a noninvasive and highly reliable point-of-care tool to evaluate inflammation of the bowel. It offers comparable accuracy to endoscopy and magnetic resonance enterography. Although IUS has been incorporated into the management of inflammatory bowel disease (IBD) in other parts of the world, it has only recently arrived in the United States. However, barriers to integration of IUS into IBD care in the United States have included a lack of adoption by leading centers, lack of educational opportunities, and an unclear path for remuneration. This article provides information about the use of IUS in IBD, reviews the data comparing existing modalities of assessment of IBD with IUS, and summarizes strategies to overcome existing barriers to IUS implementation, including the newly available US-based training pathway and appropriate billing practice.
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Affiliation(s)
| | - Emma A. Picker
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, Illinois
| | - Michael T. Dolinger
- Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, Mount Sinai Hospital, Icahn School of Medicine, New York, New York
| | - David T. Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, Illinois
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25
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Nardone OM, Calabrese G, Testa A, Caiazzo A, Fierro G, Rispo A, Castiglione F. The Impact of Intestinal Ultrasound on the Management of Inflammatory Bowel Disease: From Established Facts Toward New Horizons. Front Med (Lausanne) 2022; 9:898092. [PMID: 35677820 PMCID: PMC9167952 DOI: 10.3389/fmed.2022.898092] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/25/2022] [Indexed: 11/15/2022] Open
Abstract
Intestinal ultrasound (IUS) plays a crucial role as a non-invasive and accurate tool to diagnose and assess inflammatory bowel disease (IBD). The rationale for using IUS in Crohn’s disease (CD), a transmural disease, is widely acknowledged. While the use of IUS in ulcerative colitis (UC), a mucosal disease, is often underestimated, but, recently, it is increasingly expanding. In the context of a treat-to-target approach, the role of IUS is shifting toward a monitoring tool for predicting response to therapy. Hence, adjusting therapeutic strategies based on IUS response could reduce the burden related to endoscopy and speed the decision process with the ultimate goal to alter the natural course of IBD. Assessment of bowel wall thickness (BWT) is the most reliable IUS measure. However, the development of validated and reproducible sonographic scores to measure disease activity and the identification of parameters of therapeutic response remain relevant issues to implement the daily adoption of IUS in clinical practice. Accordingly, this review focuses on the current literature investigating the impact of IUS on CD with emphasis on the concept of transmural healing (TH) and the main related advantages. We further explore new insights on the role of IUS in UC and its clinical implications.
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Affiliation(s)
- Olga Maria Nardone
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giulio Calabrese
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Anna Testa
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Anna Caiazzo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe Fierro
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Antonio Rispo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
- *Correspondence: Fabiana Castiglione,
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26
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Dolinger M, Verstockt B. Ulcerative colitis, a transmural disease requiring an accurate IUS assessment in the current treat-to-target era. United European Gastroenterol J 2022; 10:247-248. [PMID: 35230746 DOI: 10.1002/ueg2.12215] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Michael Dolinger
- Department of Pediatrics, Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, Mount Sinai Hospital, New York, New York, USA
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.,Translational Research in Gastrointestinal Disorders, Department of Chronic Disease and Metabolism, KU Leuven, Leuven, Belgium
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