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  • Gastrointestinal ultrasound in inflammatory bowel disease: an underused resource with potential paradigm-changing application

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Recent advances in clinical practice
Gastrointestinal ultrasound in inflammatory bowel disease: an underused resource with potential paradigm-changing application
  1. Robert Venning Bryant1,2,
  2. Antony B Friedman3,4,
  3. Emily Kate Wright5,6,
  4. Kirstin M Taylor3,4,
  5. Jakob Begun7,8,
  6. Giovanni Maconi9,
  7. Christian Maaser10,
  8. Kerri L Novak11,
  9. Torsten Kucharzik10,
  10. Nathan S S Atkinson12,
  11. Anil Asthana13,
  12. Peter R Gibson3,4
  1. 1 Department of Gastroenterology, The Queen Elizabeth Hospital, Adelaide, Australia
  2. 2 Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, Australia
  3. 3 Department of Gastroenterology, Alfred Hospital, Melbourne, Australia
  4. 4 Central Clinical School, Monash University, Melbourne, Australia
  5. 5 Department of Gastroenterology, St Vincent’s Hospital, Melbourne, Australia
  6. 6 University of Melbourne, Melbourne, Australia
  7. 7 Department of Gastroenterology, Mater Hospital, Brisbane, Australia
  8. 8 Mater Research Institute, University of Queensland, Brisbane, Australia
  9. 9 Department of Gastroenterology, Luigi Sacco University Hospital, Milan, Italy
  10. 10 Department of General Internal Medicine and Gastroenterology, University Teaching Hospital Lueneburg, Lueneburg, Germany
  11. 11 Division of Gastroenterology, University of Calgary, Calgary, Canada
  12. 12 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
  13. 13 Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia
  1. Correspondence to Dr Robert Venning Bryant, Department of Gastroenterology, The Queen Elizabeth Hospital, Adelaide 5011, Australia; robert.bryant{at}sa.gov.au

Abstract

Evolution of treatment targets in IBD has increased the need for objective monitoring of disease activity to guide therapeutic strategy. Although mucosal healing is the current target of therapy in IBD, endoscopy is invasive, expensive and unappealing to patients. GI ultrasound (GIUS) represents a non-invasive modality to assess disease activity in IBD. It is accurate, cost-effective and reproducible. GIUS can be performed at the point of care without specific patient preparation so as to facilitate clinical decision-making. As compared with ileocolonoscopy and other imaging modalities (CT and MRI), GIUS is accurate in diagnosing IBD, detecting complications of disease including fistulae, strictures and abscesses, monitoring disease activity and detecting postoperative disease recurrence. International groups increasingly recognise GIUS as a valuable tool with paradigm-changing application in the management of IBD; however, uptake outside parts of continental Europe has been slow and GIUS is underused in many countries. The aim of this review is to present a pragmatic guide to the positioning of GIUS in IBD clinical practice, providing evidence for use, algorithms for integration into practice, training pathways and a strategic implementation framework.

  • Inflammatory bowel disease
  • gastrointestinal ultrasound
  • mucosal healing

https://doi.org/10.1136/gutjnl-2017-315655

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    Footnotes

    • Contributors RVB, AF, EKW, JB, KT, AA and PRG provided substantial contribution to the conception and design of the work. All authors contributed to drafting and critical revision of the manuscript. The final version of the manuscript was approved by all coauthors.

    • Funding RVB has received speaker honoraria from AbbVie, Shire Australia, Janssen, Takeda Pharmaceuticals Australia. He received conference travel support from Ferring Australia and Takeda Pharmaceuticals Australia. He has received research and/or operational infrastructure support from Ferring Australia and Takeda Pharmaceuticals Australia. He has received funding from a GESA/Ferring IBD Clinician Establishment Award. AF has received speaker fees from AbbVie, Janssen–Cilag, Takeda Pharmaceuticals Australia, Shire Australia. He has received research funding for investigator-driven studies from AbbVie. He has received travel grants from Pfizer and Ferring. PRG has served as consultant or advisory board member for AbbVie, Ferring, Janssen, Merck Sharp & Dohme, Nestle Health Science, Danone, Allergan, Pfizer, Celgene and Takeda. His institution has received speaking honoraria from AbbVie, Janssen, Ferring, Takeda, Mylan, Danone and Pfizer. He has received research grants for investigator-driven studies from AbbVie, Janssen, Danone and A2 Milk Company. His department financially benefits from the sales of a digital application and booklets on the low FODMAP diet. He has published an educational/recipe book on diet. KT has served as an advisory board member for Merck Sharp & Dohme, has received speaker fees from AbbVie and travel grants from Aspen and Shire. GM has received speaker honoraria from AbbVie, Janssen, Takeda, Alfa Wasserman Poland and Italy, served as consultant or advisory board for Novartis, Alfa Wasserman, THD and Allergan. CM has served as an advisory board member for Janssen, MSD and Takeda, has received speaker fees from AbbVie, Falk Foundation, Ferring, Janssen, MSD, Shire, Takeda and financial support for clinical ultrasound studies from AbbVie. TK has served as consultant or advisory board member or received speaker fees from AbbVie, Biogen, Falk Foundation, Ferring, Jannsen, MSD, Mundipharma, Shire, Takeda, UCB as well as financial support for clinical ultrasound studies from AbbVie and Takeda. KLN has received consultative and speaker fees from AbbVie and Janssen Pharmaceuticals. She has also participated on advisory boards for Pfizer, AbbVie, Janssen Pharmaceuticals and Takeda Pharmaceutical. EKW has received consulting and speaker fees from AbbVie, Pfizer, Falk Foundation and Janssen. She has received research grants for investigator-driven studies from AbbVie and infrastructure support also from AbbVie. She has received funding from a GESA/Ferring IBD Clinican Establishment Award. JB has served as an advisory board member or consultant for AbbVie, Janssen, Takeda, Pfizer and Ferring Pharmaceuticals. He has received research grants from Ferring. He has received speaker honoraria from AbbVie, Janssen, Takeda, Pfizer, Shire and Ferring Pharmaceuticals. NSSA has received conference travel support from Napp Pharmaceuticals.

    • Competing interests None declared.

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

    • Correction notice This article has been corrected since it published Online First. The second and fourth author names have been updated as well as the legend for figure 6.