Intestinal ultrasound reliably predicts fecal loading in patients with ulcerative colitis

Constipation commonly causes abdominal symptoms in ulcerative colitis (UC). Intestinal ultrasound (IUS) shows promise for assessing fecal loading, but parameters remain poorly defined. The primary aim of this study was to validate IUS parameters against computed tomography (CT). A secondary aim was to assess sonographic changes following constipation management.

In this single-center, prospective, blinded study, adults with UC were prospectively enrolled if fecal loading was suspected on IUS. Same-day CT was performed, followed by catharsis and repeat IUS. Sonographic parameters (colonic diameter, posterior acoustic shadowing [PAS]) were compared with CT (diameter > 50 mm or Leech > 2) using logistic regression and ROC analysis. Central reading of IUS was performed, and inter-rater reliability was assessed with intraclass correlation coefficients (ICCs). Irritable bowel syndrome severity score (IBS-SSS), Simple Colitis Clinical Activity Index (SCCAI), and sonographic parameters were captured before and after constipation management. Australia New Zealand Clinical Trials Registry: ACTRN12622001207707.

Sixty-three patients were enrolled (mean age 47 years; 52% Montreal E2; 16% actively inflamed); of these, 43 patients presented for follow-up IUS. IUS revealed a strong correlation for fecal loading across segments compared with CT (r = .7, P < .001). ROC analysis determined that a right and left colonic diameter of 39.6 and 25 mm, respectively, predicted fecal loading (AUC 0.95 and 0.76). ICC demonstrated at least substantial agreement between IUS readers (>0.6). IBS-SSS, SCCAI, and sonographic parameters improved significantly after constipation management.

IUS may represent a reliable tool to assess fecal loading in UC. IUS correlates well with CT, and demonstrates excellent reproducibility. It is a promising tool for managing constipation in UC.