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. 2025 Sep 1;16(9):e00881.
doi: 10.14309/ctg.0000000000000881.

Relationship of Intestinal Ultrasound With Clinical, Biochemical, and Endoscopic Disease Severity in Acute Severe Ulcerative Colitis: A Blinded, Prospective Study

Phillip Gu  1 , David Ziring, Puja V Khanna, Waseem Ahmed, Eric Vasiliauskas, Andres Yarur, Stephan Targan, Dermot P B McGovern, Shervin Rabizadeh, Phillip Fleshner, Maria T Abreu, Gil Y Melmed
Affiliations

Relationship of Intestinal Ultrasound With Clinical, Biochemical, and Endoscopic Disease Severity in Acute Severe Ulcerative Colitis: A Blinded, Prospective Study

Phillip Gu et al. Clin Transl Gastroenterol. .

Abstract

Introduction: The utility of intestinal ultrasound (IUS) for acute severe ulcerative colitis (ASUC) is understudied. We correlated IUS to clinical, biochemical, and endoscopic disease severity in ASUC.

Methods: In a blinded, prospective study of 20 ASUC subjects, we analyzed standard IUS parameters (bowel wall thickening, vascular flow, wall stratification) and UC IUS indices (International Bowel Ultrasound Segmental Activity Score (IBUS-SAS), Milan-UC, UC-IUS) alongside modified Mayo symptoms scores, C-reactive protein (CRP), albumin, and UC Endoscopic Index of Severity (UCEIS). Spearman correlations were performed (rs). Area under the curve (AUC) determined utility of IUS for detecting severe endoscopic disease.

Results: All IUS indices correlated with stool frequency (rs: 0.45-0.58, P < 0.001), CRP (rs: 0.56-0.59, P < 0.02), and UCEIS (rs: 0.54-0.69, P < 0.03). IBUS-SAS (AUC 0.91) and Milan-UC (AUC 0.93) outperformed IUS-UC (AUC 0.82) for detecting UCEIS ≥5. Loss of bowel wall stratification correlated strongest with CRP (rs: 0.8, P = 3.61e -8 ) and UCEIS (rs: 0.50, P = 0.047).

Discussion: IUS offers an accurate and noninvasive method to evaluate ASUC severity and treatment response.

Keywords: biomarker; inflammatory bowel disease; intestinal ultrasound; ulcerative colitis.

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Conflict of interest statement

Guarantor of the article: Phillip Gu, MD.

Specific author contributions: PG: Conceptualization; data analysis; writing – original draft; writing – review and editing, approval of final draft. DZ: writing – review and editing, approval of final draft. PVK: writing – review and editing, approval of final draft. WA: writing – review and editing, approval of final draft. EV: writing – review and editing, approval of final draft. AY: writing – review and editing, approval of final draf. tST: writing – review and editing, approval of final draft. DPBM: writing – review and editing, approval of final draft. SR: writing – review and editing, approval of final draft. PF: writing – review and editing, approval of final draft. MTA: writing – review and editing, approval of final draft. GYM: conceptualization; writing – review and editing, approval of final draft.

Financial support: Cedars-Sinai CTSI Clinical Scholars Award.

Potential competing interests: PG: AbbVie (consulting). DZ: AbbVie, Prometheus Labs, and Regeneron (Speaking fees). PVK, WA and EV: None. AY: Bristol Myers Squibb, Arena, Pfizer, Takeda and Landos (Consulting). ST: Seaver Foundation for Austim (Serves on the scientific advisory board) and Promethus Biosciences Inc (Stock options). DPBM: Takeda, Prometheus Biosciences Inc, Prometheus Labs, and MERCK. (Consulting). PF: Takeda (Consulting). SR: Prometheus and Janssen (Advisory Board). MTA: AbbVie Inc, Arena Pharmaceuticals Inc [now Pfizer], Bristol Myers Squibb, Celsius Therapeutics, Eli Lilly and Company, Gilead Sciences Inc, Janssen Pharmaceuticals, Janssen Global Services, Pfizer Pharmaceutical, Prometheus Biosciences, UCB Biopharma SRL (Consulting or advisory boards). Alimentiv, Janssen Pharmaceuticals, Prime CME and WebMD Global LLC (Speaking fees). GYM: Abbvie, Arena Pharmaceuticals, Bristol-Myers Squibb, Boehringer-Ingelheim, Celgene, Dieta, Entasis, Fresenius Kabi, Genentech, Gilead, Janssen, Medtronic, Merck, Oshi, Prometheus Labs, Pfizer, Takeda, Techlab (Consulting).

IRB: This was IRB approved (IRB#2688).

References

    1. Kaplan GG, McCarthy EP, Ayanian JZ, et al. Impact of hospital volume on postoperative morbidity and mortality following a colectomy for ulcerative colitis. Gastroenterology 2008;134(3):680–7. - PubMed
    1. Randall J, Singh B, Warren BF, et al. Delayed surgery for acute severe colitis is associated with increased risk of postoperative complications. Br J Surg 2010;97(3):404–9. - PubMed
    1. Ahmed NS, Krawchuk S, Buhler KA, et al. US national estimates of contemporary mortality rates in patients with ulcerative colitis undergoing colectomy. Am J Gastroenterol 2025;120(2):478–81. - PubMed
    1. Motwani KK, Alizadeh M, Abutaleb A, et al. Correlation between serum and fecal biomarkers and patient-reported outcomes in patients with Crohn's disease and ulcerative colitis. Dig Dis Sci 2024;69(6):2154–63. - PubMed
    1. Ilvemark J, Wilkens R, Thielsen P, et al. Early intestinal ultrasound predicts intravenous corticosteroid response in hospitalised patients with severe ulcerative colitis. J Crohns Colitis 2022;16(11):1725–34. - PubMed