Living with IBD can mean lots of doctor appointments, poking, prodding, tests, and scans. Many of which are invasive. In the world of IBD the clearest picture is painted by the intestines themselves, and the best way to see that picture currently is by flexsigoscopy or colonoscopy. By being able to see the tissue and inflammation first hand, doctors can get a better understanding of what’s going on and can adjust care accordingly. Unfortunately, these tests involve prep and usually some sort of anesthetic. Having to have these invasive tests done regularly is draining and can be expensive. The good news? Researchers in Italy have found a noninvasive way to monitor mucosal healing in CD using ultrasounds.
One of the main factor’s gastroenterologists take into account during these scans is the mucosal assessment of tissue. Mucosal healing leads to better outcomes, especially in Crohn’s disease. The research and findings of this study were recently published in Clinical Gastroenterology and Hepatology and outlined 255 ileocolonic CD patients over 12 months using baseline ultrasounds. These patients also received routine colonoscopies so they could confirm results. Researchers found that certain Bowel Ultrasound Scores (BSS) in correlation with Fecal Calprotectin Scores (FC) could determine disease course and severity.
In fact, those with a BSS of more than 3.52 and a FC score of 250μg/g or higher predicted a negative course. This negative course was defined as needing steroids, hospitalization, change in medication, or surgery within 12 months. Those with lower scores however, had better outcomes comparatively. This study not only confirms that bowel wall thickness and flow can predict disease activity, but that it can be successfully monitored in a noninvasive way. This BSS tool along with FC can help identify high risk patients, and allows for quicker response time to change course of treatment for better outcomes with less long-term damage.
Dr. Mariangela Allocca from Humanitas University and Research Hospital in Milan, Italy, has more exciting news, as they are working on noninvasive monitoring of Ulcerative Colitis as well. By using the Milan ultrasound criteria (MUC), they have been able to assess endoscopic activity for UC. Their initial findings are that a score of more than 6.2 is the threshold, and is also defined as a Mayo score of more than 2. Dr. Allocca and team have even started a longitudinal study to show the predictive value of MUC in UC. While both of these studies will need to be repeated, and on a larger scale, it is promising that noninvasive monitoring for IBD is on the upcoming horizon.
As an IBD patient myself, and someone who struggles with needles and IVs, I am all for noninvasive procedures to monitor my UC activity. The main caveat to this being, that is your doctor needs tissue or biopsy samples, they will still have to use the more traditional methods of flex sig and colonoscopy. You also may need to have one of these procedures done annually, but using ultrasound could drastically cut back on the number of invasive procedures for the sole purpose of monitoring disease. It may be a few years before we see this as a widely used practice, but I am excited that a noninvasive option is being tested and considered. Who’s with me?
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