Journal Article Multicenter Study Ppublish
PubMed: 41997335 DOI: 10.1016/j.cgh.2026.03.042
Use of Intestinal Ultrasound in a Tight Monitoring Approach in Crohn's Disease: A Multicenter Prospective Study.
Clin Gastroenterol Hepatol 24(11):3100-3110
Authors: Carolina Palmela, Joana Revés, Catarina Frias-Gomes, Bárbara Morão, Catarina Neto, André Bargas, Luísa Glória, Marília Cravo, Marta Manso, Francisca Dias de Castro, Tiago Cúrdia Gonçalves, José Cotter, Rosa Coelho, Ana Caldeira, Joana Torres
Affiliations
- Gastroenterology Division, Hospital Beatriz Ângelo, Unidade Local de Saúde de Loures/Odivelas, Loures, Portugal.
- Gastroenterology Division, Hospital Beatriz Ângelo, Unidade Local de Saúde de Loures/Odivelas, Loures, Portugal; Gastroenterology Division, Hospital da Luz Lisboa, Lisboa, Portugal.
- Gastroenterology Division, Hospital Beatriz Ângelo, Unidade Local de Saúde de Loures/Odivelas, Loures, Portugal.
- Gastroenterology Division, Hospital da Luz Lisboa, Lisboa, Portugal.
- Radiology Division, Hospital Beatriz Ângelo, Unidade Local de Saúde de Loures/Odivelas, Loures, Portugal.
- Gastroenterology Division, Unidade Local de Saúde do Alto Ave, Guimarães, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's -PT Government Associate Laboratory, Braga, Portugal.
- Gastroenterology Division, Unidade Local de Saúde de São João, Porto, Portugal.
- Gastroenterology Division, Hospital Amato Lusitano, Unidade Local de Saúde de Castelo Branco, Castelo Branco, Portugal.
- Gastroenterology Division, Hospital Beatriz Ângelo, Unidade Local de Saúde de Loures/Odivelas, Loures, Portugal; Gastroenterology Division, Hospital da Luz Lisboa, Lisboa, Portugal; Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
Abstract
BACKGROUND & AIMS
Intestinal ultrasound (IUS) is increasingly used to monitor Crohn's disease (CD) activity, yet its optimal role in tight monitoring strategies remains unclear. We aimed to assess the predictive role of ultrasonographic parameters in determining endoscopic remission (ER) after one year of anti-tumor necrosis factor α, and the correlation of IUS parameters with other outcomes longitudinally.
METHODS
This was a multicentric prospective longitudinal study enrolling adult patients with active CD starting anti-tumor necrosis factor α. Biomarkers and IUS were performed at baseline, week (W)14, W30, and W54; ileocolonoscopy and magnetic resonance enterography were performed at baseline and W54. The primary outcome was the predictive value of IUS remission (normalization of bowel wall thickness [BWT], stratification, vascularization, and mesenteric fat) for ER at W54 (segmental Simple Endoscopic Score for Crohn's Disease = 0). The International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) optimal cut point to detect ER was identified using receiver operating characteristic analysis.
RESULTS
Sixty-three patients were included, of whom 57 were followed until W54. After 1 year of therapy, 40%, 42%, and 33% achieved endoscopic, IUS, and magnetic resonance enterography remission, respectively. Patients with ER had a significantly lower median BWT and IBUS-SAS score at all time points. The best predictors for ER were IBUS-SAS <56.6 (area under the curve = 0.861) and BWT <2.9 mm (area under the curve = 0.802) at W14. On multivariable analysis, IBUS-SAS <56.6 at W14 was the only independent predictor for ER (odds ratio, 19.0; 95% confidence interval, 1.91-189.6; P = .012).
CONCLUSIONS
Early IUS evaluation can noninvasively predict treatment outcomes, supporting its integration into tight monitoring protocols for CD. IUS offers a real-time, cost-effective alternative to endoscopy and imaging, potentially enabling timely therapy optimization to improve patient management.
MeSH
Crohn Disease, Therapeutics, Prospective Studies