Gastroenterology & GI Surgery

Intestinal Ultrasound Transforms Assessment of Inflammatory Bowel Disease

June 13, 2023 - Eden McCleskey

There's a new piece of equipment shaking things up in inflammatory bowel disease (IBD) clinics: intestinal ultrasound machines.

At Houston Methodist, the first U.S.center to provide intestinal ultrasounds to adult patients, the technology has transformed clinical practice and revolutionized how physicians evaluate IBD.

"Intestinal ultrasound allows us to see what's happening inside the intestines in real time," said Dr. Bincy Abraham, the Houston Methodist IBD specialist who first brought intestinal ultrasound capability to the U.S. in 2019. "We use it on every patient at every clinic visit, and it replaces the need for a colonoscopy probably 99 percent of the time."

IBD, which includes Crohn's disease and ulcerative colitis, has long presented management challenges for patients and physicians alike. Traditionally, assessing disease activity required invasive and time-consuming procedures, requiring sedation, fasting and bowel preparation.

"Instead of seeing the patient in clinic one day, then ordering a bunch of tests that might take weeks or months for them to schedule and complete, then trying to get the patient back in to discuss next steps and hoping things haven't changed by then, ultrasound allows us to assess the patient's condition and make treatment decisions right at the point of care," Dr. Abraham said. "I can't emphasize enough how much of a game-changer this is for IBD."

Improving outcomes

A Houston Methodist study published in Crohn's & Colitis 360 recently confirmed the clinical benefits of intestinal ultrasound, or IUS, in the management of IBD.

Looking at the medical records of 148 patients, Dr. Abraham and co-author EnMed student Adam Saleh found a significant correlation between IUS results and clinical scoring systems commonly used to assess disease severity, such as the Ulcerative Colitis Activity Index (UCAI) and Mayo scores.

The research demonstrated that clinical decisions guided by IUS findings led to a reduction in inflammation among IBD patients. Follow-up evaluations confirmed the effectiveness of the treatment plans, with observed improvements in intestinal thickening, vascular flow and mural stratification.

"Our findings indicate that IUS should be strongly considered by IBD clinicians as a valuable tool for monitoring disease activity," said Dr. Abraham. "By providing objective assessments of inflammation, intestinal ultrasound can enhance the accuracy of treatment decisions and ultimately improve patient outcomes."

Benefits of intestinal ultrasound

One of the key advantages of IUS is its ability to visualize all layers of the intestine. While colonoscopies provide a direct view of the mucosal layer, IUS can assess the submucosa and surface layers.

The accurate depiction of the GI tract provides physicians with real-time information regarding the presence of inflammation. Physicians can display ultrasound images on a screen, showing patients' areas of abnormality, such as inflamed sections, increased blood flow, or excessive fat accumulation.

This visual representation is particularly valuable in cases where inflammation or strictures are located beyond the reach of a colonoscope.

"When you do a colonoscopy and the patient has a stricture somewhere in the small bowel, you can't get past it, so you can't see what's going on beyond that narrowed spot," Dr. Abraham explained.

By scanning the abdomen, physicians can detect abnormalities and assess the extent of inflammation and scar tissue. The ability to visualize the full thickness of the intestine allows for better decision-making regarding surgical interventions or medication adjustments.

"Although it does not completely replace the need for periodic colonoscopies for colon cancer screening or polyp removal, for example, it significantly reduces the number of colonoscopies required solely for assessing disease activity," Dr. Abraham stated. "The vast majority of patients can now avoid unnecessary and invasive procedures, resulting in improved patient experiences and reduced health care costs."

Improving access

While IUS has been routinely employed in European countries for years, its implementation in the United States has remained limited.

Dr. Abraham is on a mission to change that, spearheading efforts to train physicians across the country on how to incorporate intestinal ultrasound into their clinical practice.

"As the incredible utility of intestinal ultrasound continues to be recognized, it is only a matter of time before it becomes an integral part of routine care for IBD patients," Dr. Abraham said.