Use of Intestinal Ultrasound in a Tight Monitoring Approach in Crohn's Disease: A Multicenter Prospective Study

Area of Science:

• Gastroenterology
• Medical Imaging
• Inflammatory Bowel Disease

Background:

• Intestinal ultrasound (IUS) is increasingly utilized for monitoring Crohn's disease (CD) activity.
• The precise role of IUS in intensive monitoring strategies for CD requires further clarification.

Purpose of the Study:

• To evaluate the predictive capacity of ultrasonographic parameters for achieving endoscopic remission (ER) after one year of anti-tumor necrosis factor alpha (anti-TNFα) therapy in CD patients.
• To assess the longitudinal correlation between IUS parameters and other clinical outcomes.

Main Methods:

• A multicenter prospective longitudinal study involving adult CD patients initiating anti-TNFα therapy.
• Biomarkers and IUS were assessed at baseline, week 14, week 30, and week 54. Endoscopic remission was defined as a segmental Simplified Endoscopic Disease Activity Score (SES-CD) of 0.
• The International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) was analyzed using ROC analysis to identify the optimal cut-point for detecting ER.

Main Results:

• Of 63 patients, 57 completed the 54-week follow-up. Endoscopic remission was achieved by 40% of patients after one year.
• Patients achieving ER exhibited significantly lower median bowel wall thickness (BWT) and IBUS-SAS scores at all time points.
• At week 14, IBUS-SAS < 56.6 (AUC 0.861) and BWT < 2.9 mm (AUC 0.802) were the strongest predictors of ER. IBUS-SAS < 56.6 at week 14 was the sole independent predictor of ER (OR 19.0, p=0.012).

Conclusions:

• Early IUS assessment can non-invasively predict treatment outcomes in Crohn's disease patients.
• IUS shows promise for integration into tight monitoring protocols, offering a cost-effective, real-time alternative to endoscopy and MRI.
• Timely optimization of anti-TNFα therapy may be facilitated by incorporating IUS into patient management strategies.