Intestinal Ultrasound Predicts Response to Therapy in Ulcerative Colitis

A prospective, longitudinal study of patients with ulcerative colitis (UC) with endoscopic Mayo scores [EMS] ≥2 beginning anti-inflammatory treatment found that intestinal ultrasound (IUS) functions as a surrogate marker of endoscopy enabling close monitoring of treatment response.

The investigators assessed the clinical scores, biochemical parameters, and IUS of 51 patients at baseline (W0), at week 2 (W2), and at week 6 (W6); 33 patients also underwent a second endoscopy (W8-W26). “Per colonic segment, endoscopic remission (EMS = 0), improvement (EMS ≤1), response (decrease in EMS ≥1), and clinical remission (Lichtiger score ≤3) were assessed and correlated with common IUS parameters,” they reported.

They also assessed drug-specific responsiveness of bowel wall thickness (BWT), finding that this criterion was lower from week 6 onward among patients who achieved endoscopic improvement, remission, and clinical remission. Decrease in BWT was greater among endoscopic responders during the period week 8 to week 26.

“At W6, BWT ≤3.0 mm (odds ratio [OR], 25.13; 95% confidence interval, 2.01-3.14; P = .012) and color Doppler signal (OR, 0.35; 95% confidence interval, 0.14-0.88; P = .026) predicted endoscopic remission and improvement, respectively,” the authors noted. “Submucosal layer thickness at W6 predicted endoscopic remission (OR, 0.09; P = .018) and improvement (OR, 0.14; P = .02). Furthermore, BWT decreased significantly at W2 for infliximab and tofacitinib and at W6 for vedolizumab.”

Reference:

de Voogd FA, Bots SJ, van Wassenaer EA, et al. Early intestinal ultrasound predicts clinical and endoscopic treatment response and demonstrates drug-specific kinetics in moderate-to-severe ulcerative colitis. Inflammatory Bowel Diseases. 2024;30(11):1992 -2003   https://doi.org/10.1093/ibd/izad274