scholarly journals Measurement of Bowel Wall Thickness by Transabdominal Ultrasonography Is Useful to Detect the Inflammation of Colon in Ulcerative Colitis Patients : A Retrospective Study

2020 ◽  
Author(s):  
Masahiro Takahara ◽  
Sakiko Hiraoka ◽  
Masayasu Ohmori ◽  
Kensuke Takei ◽  
Eriko Yasutomi ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Wall Thickness ◽  
Bowel Wall ◽  
Mucosal Inflammation ◽  
Trend Test ◽  
Positive Finding ◽  
Transabdominal Ultrasonography ◽  
Non Invasive ◽  
Bowel Wall Thickness ◽  
Invasive Method

Abstract Background: Transabdominal ultrasonography (TUS) is a non-invasive method that can be performed repeatedly. Although the usefulness of TUS in ulcerative colitis (UC) has been reported, no well-established data exist yet. This study aimed to determine the usefulness of TUS, compared with colonoscopy (CS), in detecting the presence of mucosal inflammation in each segment of the colon among patients with UC. Methods: Eighty UC patients who underwent US within 14 days after CS were retrospectively registered. We divided the colon into five segments and measured the bowel wall thickness (BWT) using TUS. The results were then compared with the Mayo endoscopic subscore classification (MES) in order to determine their accuracy.Result: We evaluated a total of 268 lesions for each segment among 80 UC patients. The proportion of BWT decreased with an increase in the MES of each segment (p < 0.0001, Cochran-Armitage trend test). The sensitivity, specificity, and accuracy of positive BMT (BWT >2 mm) for detecting mucosal inflammation (MES >0) of each segment were 0.85-1.00, 0.78-0.93, and 0.87-0.98, respectively. Conclusion: This study concluded that TUS was a useful method for detecting the presence or absence of inflammation sites among UC patients due to its high accuracy when BMT >2 mm was considered as a positive finding. This non-invasive method may help control the disease activity of UC.

Ultrasonographic Evaluation of Bowel Wall Thickness and Intramural Blood Flow in Ulcerative Colitis

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Moataz Mohamed Sayed ◽  
Kamal El-Deen Abdelrahman El-Atrebi ◽  
Tari Magdy Aziz George ◽  
Hazem Mohamed Abd Elazim Marey
Keyword(s):  
Ulcerative Colitis ◽  
Disease Activity ◽  
Wall Thickness ◽  
Bowel Wall ◽  
Bowel Movement ◽  
Control Group ◽  
P Value ◽  
Bowel Wall Thickness ◽  
Pathologic Features ◽  
Relapse Group

Abstract Background Ulcerative colitis, a type of inflammatory bowel disease that merely affects the mucosa and submucosa of colon in the form of inflammatory ulcers. Colonoscopy is the gold standard for its diagnosis. For optimal monitoring of disease activity in UC patients, colonoscopy should be performed on a regular basis. However, repeated colonoscopies represent a logistic and economic challenge, as well as significant burden for the patients. Objectives Our study aimed to provide an extensive overview of the main pathologic features of gut wall vessels and bowel wall thickness at US examination of UC. Patients and Methods This prospective case control study was done on 40 patients confirmed to have UC attending to Outpatient Clinics of Internal Medicine and Gastroenterology Department – Ain-Shams University from October 2018 to Augost 2019. They were divided into two groups: Relapse group: Include 20 patients with active UC disease. Remission group: Include 20 patients with inactive UC disease (in remission state). These two groups were matched with 20 healthy individuals, matched for age and gender and considered to be a control group. Disease activity was categorized according to the endoscopic Mayo score.Ultrasound and endoscopic findings were compared for each colon segment except for the rectum. Results The peak incidence of affected patients was 30–40 years of age. Female predominance compared to male with a ratio of 2.6:1. 20% of remission patients complaining from 1-2 bowel movement while 45% and 50% of relapsing patients suffer from 3-4 and 5 bowel movement respectively. 100%, 100%, 20% and 15% of relapsing patients suffer from bleeding per rectum, abdominal pain, tenesmus and urgency. Higher ESR and CRP and lower hemoglobin in relapsing compared to remission group. Furthermore, The last group has higher value of ESR and CRP and lower value of hemoglobin compared to control group. BWT was significantly thicker in relapse group (4.8±0.7 mm) than of remission (3.55±0.5 mm) compared to control group (1.6±0.5) (p value &lt;0.001). BWT at a cut-offs &gt; 4 mm discriminating between cases with relapse from those with remission and at a cut-offs &gt;4 mm discriminating between mild endoscopic severity from moderate and severe UC. Furthermore, BWT at a cut-offs &gt;4.6 mm discriminating between mild and moderate endoscopic severity from severe UC. Vascular signal number at a cut-offs &gt;1 discriminating between cases with relapse from those with remission and at a cut-offs &gt;2 discriminating between mild and moderate endoscopic severity of UC. Conclusion Abdominal ultrasound is a widely available non-invasive method for imaging of UC. It provides a high sensitivity, specificity and accuracy in diagnosis and monitoring of UC activity.

scholarly journals P283 Decrease in bowel wall thickness at intestinal ultrasound accurately detects early endoscopic remission and improvement in ulcerative colitis patients on tofacitinib: a longitudinal prospective cohort study

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S315-S317
Author(s):  
F de Voogd ◽  
E Van Wassenaer ◽  
A Mookhoek ◽  
S Bots ◽  
S Van Gennep ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Disease Activity ◽  
Wall Thickness ◽  
Bowel Wall ◽  
Treatment Effectiveness ◽  
Observer Agreement ◽  
Close Monitoring ◽  
Bowel Wall Thickness ◽  
Endoscopic Remission

Abstract Background To assess disease activity in ulcerative colitis (UC) intestinal ultrasound (IUS) highly correlates with endoscopic outcomes. However, data on treatment response evaluated with IUS is limited. In this study we aim to evaluate bowel wall thickness (BWT) at follow-up to determine treatment effectiveness in moderate-severe UC patients treated with tofacitinib according to central read endoscopy and histology. Methods Patients with moderate-severe UC (endoscopic Mayo score (EMS)≥2) starting tofacitinib 10 mg bid were included. Disease activity was evaluated by recorded IUS cine-loops and video-taped endoscopies with biopsies from the sigmoid (SC) and descending colon (DC) at baseline and at 8 weeks. BWT and EMS were assessed per segment (SC and DC). Histology was scored for the SC with the Robarts Histology Index (RHI). BWT, EMS and RHI were centrally read and for IUS there was a second reader. Endoscopic remission (ERem) was defined as EMS=0, endoscopic improvement (EI) as EMS≤1 and endoscopic response (ERes) as a decrease of EMS≥1. For statistical analysis a Wilcoxon signed-rank and Spearman’s test were used. Area under the ROC was used to determine optimal cut-off values. Inter-observer agreement was analyzed by intra-class correlation coefficient (ICC). Results 29 patients were included and started tofacitinib. 10% reached complete ERem after 8 weeks, respectively. Per-segment analysis for EMS showed 22% and 53% reaching ER and 40% and 60% having EI in the SC and DC, respectively. BWT in SC and DC correlated highly with the EMS (rho=0.68, rho=0.75, both p&lt;0.0001) and moderately with RHI (rho=0.49, p=0.002). Patients with EMS≥2 after 8 weeks had an increased BWT (SC: 4.32 ± 1.57 mm, DC: 4.38 ± 1.58 mm) when compared to ERem (SC: 2.10 ± 0.67 mm, DC: mean: 2.00 ± 1.18 mm, both p&lt;0.0001) and EI (SC: 2.29 ± 0.76 mm, DC: 2.56 ± 1.38 mm, both p&lt;0.0001) in the similar segment (Figure 1 and 2). BWT decreased after 8 weeks when there was ERes (SC: mean: -2.59 ± 1.44 mm, DC: -1.82 ± 1.01 mm, both p=0.007) and did not when there was no ERes (Figure 3). BWT cut-off values for ERem are reported in Figure 4. Furthermore, agreement for BWT in the SC and DC was excellent (ICC: 0.92 and ICC: 0.89), respectively. Conclusion BWT reduction showed early endoscopic remission, improvement and response after 8 weeks of tofacitinib treatment and correlated with histology in this central read cohort. Furthermore, accurate and reliable cut-off values for BWT in SC and DC were found for endoscopic remission and improvement. Therefore, IUS should be incorporated in the standard follow-up and close monitoring of UC patients.

PP65 ULTRASOUND SCAN WITH BOWEL WALL THICKNESS EXAMINATION, IN ACUTE SEVERE ULCERATIVE COLITIS IN CHILDREN

2011 ◽  
Vol 43 ◽  
pp. S436
Author(s):  
A. Montemaggi ◽  
L. Tasciotti ◽  
M. Basile ◽  
M. De Maurizio ◽  
M. Paci ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Wall Thickness ◽  
Bowel Wall ◽  
Ultrasound Scan ◽  
Severe Ulcerative Colitis ◽  
Bowel Wall Thickness

scholarly journals P578 Inter-observer agreement of an expert panel for gastrointestinal ultrasound in ulcerative colitis

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S486-S487
Author(s):  
F de Voogd ◽  
R Wilkens ◽  
K Gecse ◽  
M Allocca ◽  
K Novak ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Lymph Nodes ◽  
Disease Activity ◽  
Wall Thickness ◽  
Interobserver Agreement ◽  
Bowel Wall ◽  
Observer Agreement ◽  
Cross Sectional ◽  
Bowel Wall Thickness ◽  
Gastrointestinal Ultrasound

Abstract Background Gastrointestinal ultrasound (GIUS) is increasingly performed in inflammatory bowel disease to assess disease activity and treatment response. It is promising as an effective point-of-care imaging tool since it correlates well with endoscopy and other cross-sectional imaging modalities. Previous studies showed moderate to substantial interobserver agreement in Crohn’s disease. However, in ulcerative colitis (UC) inter-observer agreement for GIUS has not yet been evaluated. Therefore, we conducted a study to assess inter-observer agreement in UC. Methods Thirty patients with UC (five with clinically quiescent and 25 with active disease) were included in this study. Cine-loops were recorded for the sigmoid colon (SC) in a longitudinal and cross-sectional axis in B-mode and in colour Doppler mode. Cine-loops were scored by five independent raters blinded for clinical disease activity. The cine-loops were scored for bowel wall thickness (BWT), Doppler activity (0=no activity, 1=small spots limited to the bowel wall, 2=long stretches within the bowel wall, 3=long stretches within and outside of the bowel wall), inflammatory fat, bowel wall stratification, loss of haustration and lymph nodes (present or absent). The intraclass correlation coefficient was used for the assessment of bowel wall thickness. Fleiss’ kappa was used for all nominal variables and weighted Cohen’s kappa was used for all ordinal variables. Results Inter-observer agreement was good for bowel wall thickness (ICC: 0.7, 95% CI: 0.51–0.83, p &lt; 0.0001) [1] and moderate for Doppler signal (k=0.57, 95% CI: 0.37–0.77, p &lt; 0.0001) [2]. When Doppler signal was interpreted as absent (0) or present (1–3) the observed agreement was almost perfect (k=0.81, 95% CI: 0.69–0.92). For inflammatory fat the observed agreement was moderate (k=0.42, 95% CI: 0.29–0.58, p &lt; 0.0001). Inter-observer agreement was fair for the presence of lymph nodes (k=0.35, 95% CI:0.20–0.49, p &lt; 0.0001) and loss of stratification (k=0.22 95% CI: 0.09–0.35, p &lt; 0.001). Agreement was slight for loss of haustrations (k=0.15, 95% CI: 0.00–0.29, p = 0.046). Conclusion GIUS is a reliable imaging modality with good to moderate interobserver agreement for BWT, vascularisation and fatty wrapping in UC. These ultrasonographic parameters are important features to distinguish active from quiescent disease. References

scholarly journals P689 Patient-reported outcomes (PRO-2) and intestinal ultrasound in ulcerative colitis patients: subanalysis of the TRUST&UC study cohort

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S560-S561
Author(s):  
C Maaser ◽  
U Helwig ◽  
I Fischer ◽  
S Rath ◽  
S Kolterer ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Wall Thickness ◽  
Rectal Bleeding ◽  
Patient Reported Outcomes ◽  
Bowel Wall ◽  
Stool Frequency ◽  
Invasive Technique ◽  
Moderate Correlation ◽  
Bowel Wall Thickness ◽  
Patient Reported

Abstract Background Patient-reported Outcomes (PRO) are gaining increasing acceptance as new tools to evaluate clinical activity, especially in the context of clinical trials and evaluation of drug efficacy. However, data to support the relevance of these endpoints and their correlation to objective markers of inflammation is still lacking.1 Recently published data demonstrated the feasibility of intestinal ultrasound (IUS) as a routine monitoring technique in clinical practice for Crohn’s disease (CD) and ulcerative colitis (UC) patients.2 Thus, the importance and significance of IUS, as a patient-centric and non-invasive technique has emerged over the last years and will become more relevant in the future.With this sub-analysis of the TRUST&UC study, we aimed to investigate the correlation between improvement in ultrasound parameters and PRO-2 in UC patients. Methods TRUST&UC is a prospective, observational study including 244 patients with an increased bowel wall thickness (BWT) at baseline and active UC (SCCAI ≥ 5). These patients were analysed for the Simple Clinical Colitis Activity Index (SCCAI) subscores stool frequency, urgency and rectal bleeding. These parameters were documented for up to 4 visits (baseline, an optional visit at week 2, week 6 and week 12). Pathological stool frequency was defined as a stool frequency of ≥1 point (≥ 4 stools/day) and pathological rectal bleeding was defined as ≥1 point (traces of blood in stool); the combination of both subscores was defined as PRO-2. Results We found a positive moderate correlation between BWT and the investigated SCCAI-subscores (rectal bleeding and BWT at W12 r = 0.417; stool frequency and BWT at W12, r = 0.483; PRO-2 and BWT at W12, r = 0.518) and even W6, which is in accordance with previously reported correlations of various PROs and endoscopy in UC-patients.3 We demonstrate that patients with normalisation of BWT (sigmoid colon &lt; 4.0 mm) had a significantly higher chance of a non-pathological PRO-2 (pathological PRO-2 yes/no: 4.25 mm and 3.20 mm for week 6 (p &lt; 0.001) and 4.45 mm and 3.00 mm (p &lt; 0.001) for week 12). Conclusion With this sub-analysis of the TRUST&UC study we demonstrated that bowel wall thickness, assessed by intestinal ultrasound, had a moderate correlation with normalisation of patient-reported outcomes as early as week 6 and 12. Furthermore, patients with non-pathological PRO-2 had significantly decreased bowel wall thickness. This again supports the value of intestinal ultrasound in routine medical practice. References

scholarly journals P317 Key features of bowel ultrasonography in managing inflammatory bowel disease patients

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S312-S313
Author(s):  
A Les ◽  
R Iacob ◽  
R Costache ◽  
L Gheorghe ◽  
C Gheorghe
Keyword(s):  
Inflammatory Bowel Disease ◽  
Wall Thickness ◽  
Biological Markers ◽  
Bowel Disease ◽  
Bowel Wall ◽  
Independent Predictor ◽  
Doppler Signal ◽  
Bowel Wall Thickness ◽  
Inflammatory Bowel ◽  
Treatment Escalation

Abstract Background Bowel ultrasonography (BUS) is an accurate imaging method for detecting and monitoring inflammatory bowel disease (IBD) patients. This technique is recommended by current guidelines besides gold standard endoscopic assessment in managing IBD patients. Several BUS characteristics strongly correlate with biological markers of inflammation suggesting that these tests could be used in monitoring IBD patients but is yet unknown how these features predict the patient’s evolution. Methods Our study included 95 consecutive IBD patients (24 diagnosed with ulcerative colitis, 71 with Crohn’s disease) with both active and inactive disease at presentation. IBD diagnosis was established endoscopically and histologically. Patients with superimposed infection (viral or bacterial) and patients that had solely rectal involvement of the disease were excluded. BUS was conducted at baseline by one skilled examiner blinded to biological data. Biological markers were evaluated at baseline and all cases were prospectively followed-up for the need of therapy escalation during the next 6 months. The following BUS characteristics were registered in every patient: bowel wall thickness, alteration of wall structure, thickened mucosa or submucosa, presence of hyperechoic spots in the mucosal wall, irregularity of the external wall, Doppler signal, presence of mesenteric hypertrophy, presence of lymph nodes, and an overall assessment of the examination. No special preparation was needed before BUS. Results Of all the monitored sonographic features, the following characteristics correlated with the need of increasing treatment in the following 6 months: bowel wall thickness, altered structure of the wall, hypertrophic mucosa, Doppler signal, and the overall assessment of the examination (p &lt; 0.001). The presence of the lymph nodes, hyperechoic spots in the mucosa, thickened submucosa and the irregularity of the external wall were not statistically significant correlated with the need for treatment escalation. The strongest correlation with the need for increasing treatment was documented for a mean bowel wall thickness &gt; 5 mm and for Doppler signal presence in the bowel wall (p &lt; 0.00001). In the multivariate analysis, Doppler signal presence was the only independent predictor for the need treatment escalation during a 6-month follow-up. Conclusion The most important sonographic features with an impact on therapeutic decision making in IBD patients are: bowel wall thickness, Doppler signal, altered stratification of the wall and mesenteric hypertrophy. In our analysis, the Doppler signal was the only independent predictor for the need for step-up therapy.

scholarly journals P176 Expert consensus on acquisition and reporting of intestinal ultrasonography activity in Crohn’s disease. A prospective inter-rater agreement study

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S225-S226
Author(s):  
R T Wilkens ◽  
K Nylund ◽  
F Petersen ◽  
F De Voogd ◽  
C Maaser ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Wall Thickness ◽  
Bowel Wall ◽  
Expert Consensus ◽  
Inflammatory Activity ◽  
Rater Agreement ◽  
Delphi Consensus ◽  
Bowel Wall Thickness ◽  
Independent Expert

Abstract Background Intestinal ultrasonography (IUS) is a promising cross-sectional imaging modality used to assess transmural disease and complications in Crohn’s disease (CD). Although recently positioned as a first-line modality for evaluation as per ECCO guidelines, standard measurements, reproducibility and nomenclature have not yet been clearly established. The aim of this study was to evaluate the inter-rater agreement for parameters identified as important by experts through Delphi consensus. Methods IUS parameters demonstrating inflammatory activity were systematically reviewed in the literature and presented to IUS experts. Individual parameters were selected by a blinded Delphi consensus panel to establish relative contribution to inflammatory activity in CD. Weighted grading of each parameter was further established by expert consensus. Image acquisition for optimal measurement was established by consensus. Two phases for evaluating inter-rater variability were undertaken. Phase 1: blind review by 8 readers of 20 de-identified CD cases. Cases with poor agreement were reviewed to clarify discrepancy and improve agreement. Phase 2: an additional 30 de-identified CD cases blindly were reviewed by 12 independent expert readers. Inter-rater agreement was evaluated for all 4 key parameters. Statistics were performed using Stata 16. Bowel wall thickness (BWT) was assessed using intraclass correlation coefficient (ICC) and the ordinal parameters using weighted Cohens Kappa. Results The Delphi process reduced 12 activity parameters to 4 key contributors including BWT, color Doppler signal (CDI), inflammatory fat and bowel wall echostratification (Figure 1). BWT was regarded as pathologic if the average of 4 measurements were &gt; 3 mm for the small and large bowel, and grades of the additional parameters established (Table 1). Bowel wall thickness was comprised of 2 measurements in cross section and 2 in longitudinal orientation (Figure 2). Interobserver agreement was almost perfect for BWT: ICC=0.91 (95% CI 0.83 to 0.96) p = 0.001, while there was moderate agreement for CDI κ=0.60 (95% CI 0.48–0.72) p = 0.001. Agreement for inflammatory fat detection was also moderate with κ= 0.50 (95% CI 0.33–0.66) p = 0.001, while stratification was fair κ= 0.39 (95% CI 0.26–0.53) p = 0.001. Conclusion This expert consensus-based IUS activity score clearly establishes the reproducibility of this standardised approach to measure inflammatory activity in patients with CD. Using our method, BWT which is known as the most important parameter, is highly reproducible with CDI and inflammatory fat demonstrating moderate reproducibility. This score may provide the foundation for the future incorporation of IUS in research studies and clinical trials.

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