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Observational Study
. 2020 Sep;69(9):1629-1636.
doi: 10.1136/gutjnl-2019-319451. Epub 2019 Dec 20.

Intestinal ultrasound for monitoring therapeutic response in patients with ulcerative colitis: results from the TRUST&UC study

Christian Maaser  1 , Frauke Petersen  2 , Ulf Helwig  3 , Imma Fischer  4 , Alexander Roessler  5 , Stefan Rath  5 , Dorothee Lang  5 , Torsten Kucharzik  6 ; German IBD Study Group and the TRUST&UC study group; German IBD Study Group and TRUST&UC study group
Collaborators, Affiliations
Observational Study

Intestinal ultrasound for monitoring therapeutic response in patients with ulcerative colitis: results from the TRUST&UC study

Christian Maaser et al. Gut. 2020 Sep.

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.

Keywords: gastrointestinal ultrasound; inflammatory bowel disease; ulcerative colitis.

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Conflict of interest statement

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.

Figures

Figure 1
Figure 1
Patient disposition and analysis population. BWT, bowel wall thickness; ITT, intention-to-treat; mITT, modified intention-to-treat.
Figure 2
Figure 2
(A) Proportion of patients with increased BWT over the study period. (B) Proportion of patients with increased colour Doppler signal over the study period; comparisons of the values during the study course were performed by Cochran Q test. BWT, bowel wall thickness.
Figure 3
Figure 3
Percentage of patients with additional IUS parameters at baseline, T2W, T1, T2. IUS, intestinal ultrasound.
Figure 4
Figure 4
Correlation of SCCAI total score and FC for FC group <250 μg/g versus FC group ≥250 μg/g; number in columns represents number of patients. Mann-Whitney U test. FC, faecal calprotectin; SCCAI, Short Clinical Colitis Activity Index.
See this image and copyright information in PMC

Comment in

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