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  • Intestinal ultrasonography: a useful skill for efficient, non-invasive monitoring of patients with IBD using a clinic-based point-of-care approach

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Small bowel and nutrition
Opinion
Intestinal ultrasonography: a useful skill for efficient, non-invasive monitoring of patients with IBD using a clinic-based point-of-care approach
  1. Uday N Shivaji1,2,
  2. Jonathan P Segal3,
  3. Andrew A Plumb4,
  4. Mohammad Nabil Quraishi5,
  5. Subrata Ghosh1,6,7,
  6. Marietta Iacucci1,6
  1. 1 National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University Hospitals, Birmingham, UK
  2. 2 Gastroenterology, University of Birmingham Institute of Immunology and Immunotherapy, Birmingham, UK
  3. 3 Gastroenterology, Hillingdon Hospital, Uxbridge, UK
  4. 4 Radiology, University College London Hospitals NHS Foundation Trust, London, UK
  5. 5 University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  6. 6 University of Birmingham Institute of Immunology and Immunotherapy, Birmingham, UK
  7. 7 College of Medicine and Health, University College Cork, Cork, Ireland
  1. Correspondence to Dr Uday N Shivaji, National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University Hospitals Birmingham, UK, Birmingham B32 2AT, UK; doctoruday80{at}gmail.com

https://doi.org/10.1136/flgastro-2021-101852

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    Inflammatory bowel diseases (IBD), comprising ulcerative colitis (UC) and Crohn’s disease (CD), are chronic inflammatory conditions reported to be increasing in incidence and prevalence in high-income and newly industrialised countries.1 The diagnosis and management of IBD have evolved over decades. The diagnosis of UC is conventionally suspected by patient history, confirmed on endoscopy and supported by histological analysis. However, the diagnosis of CD depends on the location of the disease and thus ease of access for confirmatory histology. Some patients with endoscopically inaccessible disease rely on cross-sectional imaging such as CT or magnetic resonance enterography (MRE) and wireless capsule endoscopy, all of which have been reported to have high accuracy.2 3

    The sensitivity and specificity of MRE as a single modality are high, not only in the diagnosis of new and recurrent CD in terms of the longitudinal extent and location of the disease,4 but also correlate significantly with inflammation within the fibrotic segments, on histological assessment of CD-related strictures.5 It is also useful for detecting and quantifying the degree of established bowel damage.6 Therefore, the European Crohn’s and Colitis guidelines7 recommend MRE as a reliable test and is now routinely used in clinical practice. It does however have some limitations. It is expensive, requires advanced infrastructure, inconvenient for patients (requiring an additional hospital visit during which >1 L of oral contrast must be consumed followed by a 30–40 min scan, which some find claustrophobic), burdensome for healthcare systems and requires expertise to interpret the images.

    In recent years, intestinal ultrasound (IUS) has emerged as a reliable, cost-effective, non-invasive, time-efficient test, making it an attractive alternative tool for diagnosis and follow-up of patients with CD. This technique is used extensively by non-radiologist clinicians in continental Europe, Canada and Australia to manage patients with CD, but has …

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    Footnotes

    • UNS and JPS contributed equally.

    • Contributors UNS: literature search, writing and editing the manuscript, revision and final approval. JS: planning, literature search, writing and editing the manuscript, revision and final approval. AAP: writing and editing sections of the manuscript, revision and final approval. MNQ: writing and editing sections of the manuscript, revision and final approval. SG: writing and editing sections of the manuscript, critical revision and final approval. MI: writing and editing sections of the manuscript, critical revision and final approval.

    • Funding This paper presents independent research funded and supported by the NIHR Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham.

    • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.