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

Prospective evaluation of intestinal ultrasound (IUS) for disease monitoring of patients with ulcerative colitis (UC) in routine medical practice. 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. 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). 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.

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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.