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Mucosal healing is associated with better outcomes in Crohn's disease (CD) and has become the goal of therapy to prevent recurrence and structural damage. While mucosal assessment with colonoscopy is invasive and poorly tolerated, bowel ultrasound is a noninvasive tool increasingly used for CD monitoring.

Mariangela Allocca, MD, PhD, and colleagues at Humanitas University and Research Hospital in Milan, Italy, tested the predictive power of baseline ultrasound findings on disease course over 12 months. Their single-center observational study, recently published online in , followed a prospective cohort of 255 ileocolonic CD patients who also received routine colonoscopy.

Allocca outlined the two-phase study's findings in the following interview with the Reading Room.

What was the rationale for your group's undertaking this study?

Allocca: In the treat-to-target era, the need for a noninvasive approach in the management of patients with inflammatory bowel diseases has become urgent. Bowel ultrasound is an accurate, patient-friendly, and readily available tool for assessing and monitoring patients.

What was known about the role of ultrasound in predicting the course of CD before your study?

Allocca: A few studies showed that the improvement and/or normalization of some ultrasound parameters was associated with a better course of disease. This is the first to show the predictive value of actual ultrasound scores in a large cohort of CD patients.

Could you delineate the main findings of the study? Did any of them surprise you or run counter to expectation?

Allocca: We found that a bowel ultrasound score (BUSS) of more than 3.52 predicted a negative disease course. This was defined as the need for steroids and/or change or optimization of therapy, and/or hospitalization, and/or the need for surgery during a 12-month period. In the presence of baseline complications, including strictures, fistulae, and abscesses, BUSS predicted the need for surgery over 12 months.

Elevated fecal calprotectin (FC) of at least 250 μg/g at baseline was also associated with a negative disease course. So our findings support the role of combined bowel ultrasound and FC as valid tools to identify patients at high risk of disease progression in the context of a noninvasive treat-to-target approach and tight monitoring.

Did your findings align with any previous research done on this issue?

Allocca: Our study confirms the central role of bowel wall thickness and bowel wall flow in assessing disease activity, in line with previous studies. In addition, we found that both these parameters, evaluated using noninvasive bowel ultrasound, were able to predict a negative course of disease throughout 12 months.

Will the results impact practice at your hospital in the near future?

Allocca: We can perform bowel ultrasound as an alternative to colonoscopy in patients who do not require mucosal biopsies. This new approach will be strategic not only for increasing acceptability by the patients, but also for reducing healthcare costs.

What still needs to be done to clarify the predictive role of ultrasound in CD?

Allocca: Our data need to be confirmed and validated in further large studies.

Could ultrasound also be helpful predictively in ulcerative colitis (UC)?

Allocca: Recently, we developed and externally validated noninvasive ultrasound-based criteria using Milan ultrasound criteria (MUC) to assess and grade endoscopic activity in UC. We also confirmed that an MUC score of more than 6.2 is a valid cutoff threshold to discriminate endoscopic activity, as defined by a Mayo endoscopic subscore of more than 2. We are currently leading a longitudinal study designed to demonstrate the predictive value of MUC in a cohort of patients with UC.

What's the take-home message from your study to gastroenterologists treating CD?

Allocca: BUSS is an accurate tool to assess and monitor CD activity and predicts disease course. It can identify patients at high risk of a negative course and allows us to adopt effective strategies in time to prevent disease progression.

You can read the abstract of the study here, and about the clinical implications of the study here.