Bowel-ultrasound criteria accurately assess disease activity in ulcerative colitis

Last Updated: 2018-08-20

By Reuters Staff

NEW YORK (Reuters Health) - A combination of measures obtained during bowel ultrasound can accurately assess disease activity in patients with ulcerative colitis (UC), according to a new study.

Ileocolonoscopy is the standard procedure for assessing UC, but repeated colonoscopies are not well accepted by patients. Noninvasive bowel ultrasound might be a reasonable alternative, but there are few studies evaluating its accuracy for assessing disease activity and severity in UC patients.

Dr. Silvio Danese from Humanitas University in Milan, Italy, and colleagues developed noninvasive criteria based on bowel-ultrasound findings ("Humanitas ultrasound criteria," or HUC) and tested their diagnostic accuracy, compared with colonoscopy, in 53 adult patients with UC.

Independent predictors of endoscopic activity included colonic-wall thickness (CWT), with each 1-mm increase above normal (3 mm) increasing the odds of disease activity 4.05-fold (P=0.01), and colonic-wall flow (CWF), the presence of which was associated with 7.99-fold (P=0.09) increased odds of endoscopic activity.

An HUC value of 6.3 or higher (calculated as 1.4 x CWT (in mm) + 2 x CWF (present=1, absent=0)) discriminated between patients with active UC and those with nonactive UC with 71% sensitivity, 100% specificity, and 89.1% accuracy, the researchers report in the Journal of Crohn's and Colitis, online August 4.

Addition of fecal calprotectin levels did not improve the diagnostic accuracy.

Based on these results, the researchers propose the following HUC for the detection of disease activity: (1) the presence of CWF along with CWT >3 mm or (2) CWT >4.43 mm in the absence of CWF.

"Bowel ultrasound (BUS) may represent a useful first line, non-invasive tool for assessing endoscopic activity, severity and extent, and may be helpful to determine in a rapid manner whether a significant flare occurs and to guide the management of UC patients, delaying or avoiding colonoscopy, when it is not needed," the researchers conclude. "In addition, BUS may be preferred in clinical practice for monitoring disease course and for assessing short-term treatment response, reducing the necessity of repeated CS, although specific data on monitoring will be needed."

"Larger multicenter studies are needed to confirm our preliminary findings and to test the reproducibility of BUS, and of the HUC," they add.

Dr. Danese did not respond to a request for comments.

SOURCE: https://bit.ly/2wbrEAc

J Crohns Colitis 2018.