Early Intestinal Ultrasound Predicts Clinical and Endoscopic Treatment Response and Demonstrates Drug-Specific Kinetics in Moderate-to-Severe Ulcerative Colitis

Floris A de Voogd; Steven J Bots; Elsa A van Wassenaer; Maria de Jong; Maarten J Pruijt; Geert R D'Haens; Krisztina B Gecse

doi:10.1093/ibd/izad274

Early Intestinal Ultrasound Predicts Clinical and Endoscopic Treatment Response and Demonstrates Drug-Specific Kinetics in Moderate-to-Severe Ulcerative Colitis

Inflamm Bowel Dis. 2023 Nov 27:izad274. doi: 10.1093/ibd/izad274. Online ahead of print.

Authors

Floris A de Voogd¹, Steven J Bots¹, Elsa A van Wassenaer², Maria de Jong¹, Maarten J Pruijt¹, Geert R D'Haens¹, Krisztina B Gecse¹

Affiliations

¹ Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands.
² Paediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

PMID: 38011801
DOI: 10.1093/ibd/izad274

Abstract

Background: Intestinal ultrasound (IUS) is an emerging modality in monitoring disease activity in ulcerative colitis (UC). Here, we aimed to identify early IUS predictors of treatment response as evaluated by endoscopy and assessed the kinetics of IUS changes.

Methods: This prospective, longitudinal study included UC patients with endoscopic disease activity (endoscopic Mayo score [EMS] ≥2) starting anti-inflammatory treatment. Clinical scores, biochemical parameters and IUS were assessed at baseline (W0), at week 2 (W2), at W6(W6), and at the time of second endoscopy (W8-W26). Per colonic segment, endoscopic remission (EMS = 0), improvement (EMS ≤1), response (decrease in EMS ≥1), and clinical remission (Lichtiger score ≤3) were assessed and correlated with common IUS parameters. Additionally, drug-specific responsiveness of bowel wall thickness (BWT) was assessed.

Results: A total of 51 patients were included and followed, and 33 patients underwent second endoscopy. BWT was lower from W6 onward for patients reaching endoscopic improvement (3.0 ± 1.2 mm vs 4.1 ± 1.3 mm; P = .026), remission (2.5 ± 1.2 mm vs 4.1 ± 1.1 mm; P = .002), and clinical remission (3.01 ± 1.34 mm vs 3.85 ± 1.20 mm; P = .035). Decrease in BWT was more pronounced in endoscopic responders (-40 ± 25% vs -4 ± 28%; P = .001) at W8 to W26. At W6, BWT ≤3.0 mm (odds ratio [OR], 25.13; 95% confidence interval, 2.01-3.14; P = .012) and color Doppler signal (OR, 0.35; 95% confidence interval, 0.14-0.88; P = .026) predicted endoscopic remission and improvement, respectively. Submucosal layer thickness at W6 predicted endoscopic remission (OR, 0.09; P = .018) and improvement (OR, 0.14; P = .02). Furthermore, BWT decreased significantly at W2 for infliximab and tofacitinib and at W6 for vedolizumab.

Conclusions: BWT and color Doppler signal predicted endoscopic targets already after 6 weeks of treatment and response was drug specific. IUS allows close monitoring of treatment in UC and is a surrogate marker of endoscopy.

Keywords: intestinal ultrasound; treatment response; ulcerative colitis.

Plain language summary

Intestinal ultrasound (IUS) is an emerging modality to monitor treatment response in ulcerative colitis. In this study, we investigated the responsiveness of IUS parameters such as bowel wall thickness (BWT) and color Doppler signal after start of treatment and evaluated these parameters early on in treatment follow-up (week 2 and W6). We found that BWT and color Doppler signal at W2 and W6 could predict endoscopic remission and improvement later on in treatment follow-up (between W8 and W26). Furthermore, we provide accurate cutoff values for BWT to predict and determine endoscopic endpoints. The timing of monitoring treatment response is drug specific, and IUS is a surrogate marker of endoscopy.