The added value of frequent intestinal ultrasonography in the close monitoring of moderate-severe ulcerative colitis

Ulcerative colitis (UC) is an inflammatory bowel disease characterised by a pattern of relapse and remission. A moderate to severe relapse is frequently seen during disease course and needs medical treatment. Moreover, acute severe ulcerative colitis (ASUC) is a life-threatening complication, which occurs in approximately 20% to 30% of UC patients during their disease course and results in high colectomy rates since many patients fail to medical rescue treatment. In order to improve outcome, it is of major importance to assess effect of treatment in an early stage to adapt treatment accordingly. Several clinical and biochemical data predict failure to response but also show lack of reliability. Although endoscopy is the gold standard in evaluating UC disease activity, it is challenging to perform this exam repeatedly in patients. Indeed endoscopy is invasive, expensive and comes with adverse events and is therefore not optimal in the close monitoring of moderate to severe UC patients. In addition to clinical, biochemical and endoscopic parameters, cross sectional imaging may show response to treatment already in the first days to weeks. Trans-abdominal ultrasound of the colon correlates well with other radiological methods (e.g MRI and CT) and colonoscopy. Furthermore, ultrasound is a method which is non-invasive, cheap and easy to perform which makes it an excellent choice to assess disease activity frequently during the first weeks of medical treatment.

The response on medical treatment for moderate to severe ulcerative colitis is visible on intestinal ultrasound within the first 6 weeks according to endoscopic response at 8-26 weeks

Baseline, week 1, week 2, week 6 and week 8-26

Intestinal ultrasound