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Abstract
Objective Prospective evaluation of intestinal ultrasound (IUS) for disease monitoring of patients with ulcerative colitis (UC) in routine medical practice.
Design TRansabdominal Ultrasonography of the bowel in Subjects with IBD To monitor disease activity with UC (TRUST&UC) was a prospective, observational study at 42 German inflammatory bowel disease-specialised centres representing different care levels. Patients with a diagnosis of a proctosigmoiditis, left-sided colitis or pancolitis currently in clinical relapse (defined as Short Clinical Colitis Activity Index ≥5) were enrolled consecutively. Disease activity and vascularisation within the affected bowel wall areas were assessed by duplex/Colour Doppler ultrasonography.
Results At baseline, 88.5% (n=224) of the patients had an increased bowel wall thickness (BWT) in the descending or sigmoid colon. Even within the first 2 weeks of the study, the percentage of patients with an increased BWT in the sigmoid or descending colon decreased significantly (sigmoid colon 89.3%–38.6%; descending colon 83.0%–42.9%; p<0.001 each) and remained low at week 6 and 12 (sigmoid colon 35.4% and 32.0%; descending colon 43.4% and 37.6%; p<0.001 each). Normalisation of BWT and clinical response after 12 weeks of treatment showed a high correlation (90.5% of patients with normalised BWT had symptomatic response vs 9.5% without symptomatic response; p<0.001).
Conclusions IUS may be preferred in general practice in a point-of-care setting for monitoring the disease course and for assessing short-term treatment response. Our findings give rise to the assumption that monitoring BWT alone has the potential to predict the therapeutic response, which has to be verified in future studies.
- ulcerative colitis
- gastrointestinal ultrasound
- inflammatory bowel disease
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Footnotes
Contributors Study concept and design: CM, TK, UH, AR, SR and GISG (German IBD Study Group). Analysis: IF. Interpretation of data: CM, FP, UH, IF, TK, AR, SR and DL. Drafting of the manuscript: CM, FP, UH, IF, TK, AR, SR and DL. Critical revision of the manuscript for important intellectual content and approval of final version: CM, FP, UH, IF, TK, AR, SR and DL.
Funding The design, study conduct, and financial support for the study were provided by AbbVie. AbbVie participated in the interpretation of data, review and approval of the study. AbbVie provided funding to the study group for this work.
Competing interests CM received honorary fees from AbbVie, Biogen, Celgene, Ferring, Falk Foundation, Janssen, MSD Sharp & Dome, Takeda Pharma and Vifor Pharma. UH received lecture and consulting fees from AbbVie, Celltrion, MSD, Ferring, Falk Foundation, Takeda, Mundipharma, Hospira, Pfizer, Amgen, Biogen, Shield, Janssen and Vifor Pharma. IF received consulting and honorary fees from AbbVie. AR, SR and DL are AbbVie employees, and may own AbbVie stock or options. TK received honorary fees from AbbVie, Biogen, Boehringer Ingelheim, Ferring, Hospira, Mundipharma, Falk Pharma GmbH, Janssen, MSD Sharp & Dome and Takeda Pharma.
Patient consent for publication Not required.
Ethics approval The protocol was approved by the ethics committee of the Aerztekammer Niedersachsen (Bo/19/2015) on 15 July 2015 and performed in accordance with the principles of the Declaration of Helsinki.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.