Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2018 Nov 28;12(12):1385-1391.
doi: 10.1093/ecco-jcc/jjy107.

Accuracy of Humanitas Ultrasound Criteria in Assessing Disease Activity and Severity in Ulcerative Colitis: A Prospective Study

Mariangela Allocca  1   2 , Gionata Fiorino  1   2 , Stefanos Bonovas  1   2 , Federica Furfaro  1 , Daniela Gilardi  1 , Marjorie Argollo  3 , Paola Magnoni  4 , Laurent Peyrin-Biroulet  5 , Silvio Danese  1   2
Affiliations
Comparative Study

Accuracy of Humanitas Ultrasound Criteria in Assessing Disease Activity and Severity in Ulcerative Colitis: A Prospective Study

Mariangela Allocca et al. J Crohns Colitis. .

Abstract

Background: Colonoscopy [CS] is the standard for assessing disease activity in ulcerative colitis [UC], although invasive and poorly tolerated. Bowel ultrasound [BUS] may be a valid alternative in UC patients; however, the comparative accuracy between BUS and CS is unknown.

Methods: Consecutive patients with UC were prospectively assessed by CS and BUS. Colonic wall thickening [CWT >3 mm], colonic wall flow at power Doppler [CWF], colonic wall pattern [CWP], and presence of lymph nodes evaluated at BUS were compared with CS. The endoscopic activity was assessed according to the Mayo endoscopic sub-score [0-3]. All BUS investigations were performed by two independent gastroenterologists and the kappa statistic for agreement was calculated. Ultrasonography-based criteria (Humanitas Ultrasound Criteria [HUC]) were developed.

Results: A total of 53 UC patients [56% with left-sided colitis, 19% with pancolitis] were prospectively enrolled. Of these, 22 patients had mucosal healing [Mayo endoscopic sub-score 0-1] and 31 patients were in endoscopic activity. CWT, CWF, hypoechogenic CWP and the presence of lymph nodes significantly correlated with endoscopic activity [p < 0.05]. CWT [p = 0.01] and CWF [p = 0.09] were independent predictors for endoscopic activity. The HUC developed are: [i] the presence of a CWF and CWT > 3 mm; or [ii] the absence of a CWF and CWT > 4.43 mm. They showed high accuracy for the detection of disease activity [sensitivity 0.71, specificity 1.00]. The interobserver agreement for BUS was excellent [kappa 0.86].

Conclusions: BUS is a non-invasive, easy-to-use tool to manage UC patients in clinical practice. HUC were very accurate in assessing disease activity in UC patients.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Left-sided ulcerative colitis. At colonoscopy [CS], absent vascular pattern, erythema, erosions, and rare ulcers [Mayo 3] [A]. At bowel ultrasound [BUS], longitudinal and transverse sections of sigmoid colon with a 5-mm wall thickening and presence of blood signals at power Doppler. Some lymph nodes are present surrounding the pathological intestinal tract [B].
Figure 2.
Figure 2.
Left-sided ulcerative colitis. At colonoscopy [CS], absent vascular pattern, marked erythema, friability, spontaneous bleeding, and ulcerations [Mayo 3] [A]. At bowel ultrasound [BUS], longitudinal and transverse sections of sigmoid colon with a 6-mm wall thickening and presence of blood signals at power Doppler. Arrows indicate ulcers [B].
Figure 3.
Figure 3.
Changes in bowel ultrasound [BUS] parameters according to endoscopic activity.
Figure 4.
Figure 4.
Receiver operating characteristic [ROC] curve analysis measuring sensitivity and specificity of the Humanitas Ultrasound Criteria [HUC]. An HUC ≥ 6.3 [black cross] identifies the best cut-off to discriminate active versus non active ulcerative colitis [UC].
See this image and copyright information in PMC

References

    1. Silverberg MS, Satsangi J, Ahmad T, et al. . Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol 2005;19 [Suppl A]:5A–36A. - PubMed
    1. Magro F, Gionchetti P, Eliakim R, et al. ; European Crohn’s and Colitis Organisation [ECCO]. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders. J Crohns Colitis 2017;11:649–70. - PubMed
    1. Peyrin-Biroulet L, Sandborn W, Sands BE, et al. . Selecting Therapeutic taRgets in Inflammatory bowel DiseasE [STRIDE]: determining therapeutic goals for treat-to-target. Am J Gastroenterol 2015;110:1324–38. - PubMed
    1. Damore LJ II, Rantis PC, Vernava AM III, Longo WE. Colonoscopic perforations. Etiology, diagnosis, and management. Dis Colon Rectum 1996;39:1308–14. - PubMed
    1. Eckardt VF, Gaedertz C, Eidner C. Colonic perforation with endoscopic biopsy. Gastrointest Endosc 1997;46:560–2. - PubMed

Publication types