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Copyright 2023. Houston Methodist, Houston, TX. All rights reserved. The Underwood Center for Digestive Disorders Quarterly Digest Sharon Chui, System Service Line Administrator Jonathan S. Feinberg, PhD, Scientific Writer Sara Carr, Digital Graphic Designer

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Ultrasound is recommended to track inflammatory bowel disease

by Denise B. Hensley

A study published by the Crohn’s and Colitis Foundation supports ultrasound use for clinical decisions to treat inflammatory bowel disease (IBD). The research was conducted by the Texas A&M School of Engineering Medicine (EnMed) educational program and the Lynda K. and David M. Underwood Center for Digestive Disorders. “If you’re only using inflammatory biomarkers and clinical scores, based on our patient population, you’re only detecting disease activity with a 62 percent sensitivity,” said Adam Saleh who is part of the unique Houston Methodist and Texas A&M EnMed educational program, the nation’s first training program that combines medicine and engineering. Bincy Abraham, MD, MS, initiated the research. She is the Fondren Distinguished Professor in Inflammatory Bowel Disease and Director of the Gastroenterology Fellowship for the Underwood Center.

Adam Saleh

“Validation of using intestinal ultrasound (IUS) for IBD disease activity has already been established in other countries,” Saleh said, adding that the rate-limiting step is training. Fortunately, Abraham now has trained in Italy on the use of ultrasound in IBD and brought that training back to Houston to train and encourage other clinicians. Patients in the study were seen at Houston Methodist from July 2020 to March 2022. Ultrasound use was compared against more frequently used measures of inflammation. Out of 148 total patients, 62.1% (N = 92) had active disease and 37.9% (N = 56) were in remission. Ulcerative colitis activity index and Mayo scores were both significantly correlated with IUS findings. The treatment plan was significantly correlated with IUS findings (P = .004). At follow-up, an overall decrease in intestinal thickening was observed as were improvements in vascular flow and mural stratification. “Ultrasound can be done with the patient there and awake. You can show them the inflammation on the screen and tell them if you aren’t controlling it well,” he said. Saleh will graduate in May with both an MD and a masters in engineering and currently is applying for his residency to begin in Summer of 2024.