Revolutionizing UC monitoring: The emerging role of intestinal ultrasound

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by alternating periods of disease flare and remission, necessitating precise monitoring to guide therapeutic decisions. Traditionally, endoscopy has served as the cornerstone of disease assessment. However, its invasiveness, cost and limited accessibility have underscored the need for alternative approaches. Intestinal ultrasound (IUS) has emerged as a valuable, non-invasive tool capable of providing real-time information about intestinal inflammation at the bedside. This review explores the evolving role of IUS in UC monitoring and management, highlighting its utility in diagnosing disease activity, guiding therapeutic decisions, and supporting treat-to-target strategies. Despite current challenges such as operator dependency and variability in technique, growing evidence supports the incorporation of IUS into routine clinical practice, with ultrasound parameters being integrated into validated and predictive scoring systems to enhance disease monitoring and guide treatment decisions. By offering a safe, reproducible, and patient-friendly modality, IUS represents a significant advancement in the proactive management of UC, promising improved outcomes and greater quality of care.