Ultrasound Score Promising Measure of Crohn's Disease

By David Douglas

June 23, 2020

NEW YORK (Reuters Health) - An ultrasound activity index combining bowel-wall thickness and color Doppler appears to be a useful surrogate marker of endoscopic activity in patients with Crohn's disease, according to Norwegian researchers.

"To improve management of patients with Crohn's disease, objective methods should be used," Dr. Fredrik Svika of the University of Bergen told Reuters Health by email. "For optimal monitoring of disease activity, ileocolonoscopy should be used on a regular basis. However, repeated ileocolonoscopies cannot be frequently performed as (they are) invasive, resource-intensive and cause considerable patient discomfort."

What's more, endoscopic scoring systems, such as the Simple Endoscopic Score for Crohn's Disease (SES-CD), are cumbersome to use in clinical practice, Dr. Svika and colleagues point out in the Journal of Crohn's and Colitis. Biomarkers such as C-reactive protein and fecal calprotectin are well-established but they cannot depict disease location and have limited accuracy.

To try to find a simpler measure, the researchers prospectively examined a development cohort of 40 patients using both ultrasound and endoscopy.

Seven ultrasound variables were initially included in their model, and the ultrasound data from each patient was re-examined for interobserver assessment. The researchers determined that only bowel-wall thickness and color Doppler had significant contributions to the model and provided the most consistent results.

They then went on to use this approach in a validation cohort of 124 patients. There was "excellent" interobserver agreement, they write, and the ultrasound score correlated well with endoscopic activity as assessed by the SES-CD (Spearman's rho was 0.83 and 0.78 in the development and validation cohorts, respectively).

The study was limited by relying on ileocolonoscopies performed as part of standard care, the researchers note, and the examinations were conducted by several endoscopists. Also, no formal consensus regarding SES-CD calculation was performed.

Still, said Dr. Svika, "The activity score corresponds well with ileocolonoscopy, suggesting that it is a useful surrogate marker of endoscopic activity. Thus, the ultrasound score may replace some endoscopic examinations during follow-up. Although ileocolonoscopy will remain as the reference standard modality, the ultrasound score could serve as an important adjunct in facilitating patient care."

SOURCE: https://bit.ly/2NcE7g0 Journal of Crohn's and Colitis, online June 10, 2020.