A recent American Gastroenterological Association clinical practice update on the use of intestinal ultrasound (IUS) for inflammatory bowel disease may signal a tipping point for the noninvasive diagnostic tool popularized at Houston Methodist Hospital.

The guidance, published in Clinical Gastroenterology and Hepatology in September, reviews IUS techniques, the tool’s current use in practice and strategies for overcoming barriers to implementing IUS-based care, which is now widely employed in high-volume academic centers but still in limited use in private practice.

“I think this AGA statement really cements intestinal ultrasound as more than just a novel technology — it’s a new standard of care,” said Dr. Bincy Abraham, director of the Houston Methodist Underwood Center’s Fondren Inflammatory Bowel Disease Center and lead author of the update. “With its ability to assess inflammation in real time, free from the burdens of sedation or radiation, intestinal ultrasounds are reshaping the way gastroenterologists monitor and manage IBD.”

Benefits of intestinal ultrasound

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. Abraham, who 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 to assess disease activity probably 99 percent of the time."

For decades, the gold standards for diagnosis and management of IBD left a lot to be desired, ranging from anesthesia-requiring endoscopies to radiation-emitting scans to obtrusive and embarrassing stool and blood sample collection.

“Ultrasound is substantially more patient-friendly and patient-centered than traditional diagnostic methods,” Dr. Abraham asserted. “It can be performed in a matter of minutes during the patient’s in-person clinic visit, no bowel prep, no anesthesia, no separate appointments. This not only spares patients the ordeal of invasive procedures, it also facilitates more proactive and precise disease management as providers can now make on-the-spot adjustments to care.”

Improving outcomes

A Houston Methodist study published last year in Crohn's & Colitis 360 was among the first to confirm the clinical benefits of IUS in the management of IBD.

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

IUS also detected more disease activity in both Crohn's disease and ulcerative colitis patients in "biomarker remission" — where laboratory analysis appeared normal — helping providers capture more signs of disease than they could before.  

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."

Expanding access

While IUS has been employed in Europe and other countries for more than a decade, its use in the U.S. only began growing substantially in the last few years.

Dr. Abraham is on a mission to continue the momentum, spearheading efforts to train physicians across the country on how to incorporate intestinal ultrasound into their clinical practice. With the publication of the industry’s first clinical practice guidelines for IUS, Dr. Abraham continues her quest to usher in a new era of more efficient, more patient-centered, IBD care.

"Instead of seeing the patient in clinic one day, then ordering several 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."

Although still mostly only in use at high-volume IBD programs within academic medical centers, Dr. Abraham and colleagues believe it will eventually become an essential part of routine management for all patients with IBD.

"The incredible utility of intestinal ultrasound continues to be recognized by providers across the nation,” Dr. Abraham said. "I can't emphasize enough how much of a game-changer this is for anyone with IBD or anyone caring for patients with IBD."

Source of Image: https://www.sciencedirect.com/journal/clinical-gastroenterology-and-hepatology