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Bowel Ultrasound an Alternative to Colonoscopy in Diagnosing Relapsed Ulcerative Colitis: Presented at UEGW By Judith Moser, MD VIENNA, Austria -- October 21, 2008 -- In expert hands, bowel ultrasound is accurate in determining a relapse and the extent of colonic involvement in patients with a suspected recurrence of previously diagnosed ulcerative colitis, researchers noted here at the 16th United European Gastroenterology Week (UEGW). It is still a matter of debate whether patients with a diagnosis of ulcerative colitis should undergo a colonoscopy in case of a recurrence of intestinal symptoms. An Italian study aimed to evaluate the usefulness of bowel ultrasound as a surrogate of colonoscopy in assessing disease activity and disease extension. "This study was based on the assumption that, in patients with known ulcerative colitis, an invasive diagnostic method like colonoscopy -- which is generally not well accepted by the patients -- can be substituted by bowel ultrasound," explained investigator Fabrizio Parente, MD, A. Manzoni Hospital, Lecco, Italy, speaking at a poster presentation here on October 20. Clinical, endoscopic, and ultrasound parameters were compared. Eighty-six consecutive patients with known ulcerative colitis, who had been admitted for recurrence of intestinal symptoms, were included in the trial. All patients underwent both colonoscopy and bowel ultrasound before being started on any new treatment. Endoscopic disease severity was graded 0 to 3 according to the Baron score for the various colonic segments, whereas ultrasound disease severity was graded according to the maximum colonic wall thickening of the same segments. Clinical activity was graded 0 to 3 according to the Truelove score. "We found a good correlation between the wall thickness of the inflamed colonic segment and the clinical and endoscopic score," said Dr. Parente. A colonic wall thickness greater than 5 mm turned out to be directly associated with the risk of a moderate to severe endoscopic flare-up. This threshold also correlated significantly with clinical activity according to the Truelove score (P € .001). When using endoscopy as the reference test for disease activity, the researchers found a high accuracy rate for bowel ultrasound in determining disease relapse, with accuracy for the various colonic segments as follows: sigmoid colon = 93%, descending colon = 90%, transverse colon = 89%, and ascending colon = 63%. By contrast, the diagnostic accuracy of ultrasound was very poor for detecting rectal recurrence (41.8%). This is due to the well-known fact that sonographic exploration of the deep pelvis is difficult. According to Dr. Parente, bowel ultrasound has 2 limitations: (1) the increased need of expertise, as imaging of the colonic segments is usually not performed sonographically and (2) impaired visibility in overweight or bloated patients. "Nevertheless, patients with inflammatory bowel disease are normally lean," Dr. Parente added. Presentation title: Can Bowel Ultrasound Determine Disease Activity and Extension in Patients With Ulcerative Colitis Suffering From Recurrence of Intestinal Symptoms? An Endoscopic-Controlled Study. Abstract PO156 E-mail this page to a friend or colleague! To print, use this version