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Ulcerative colitis (UC) is a chronic, relapsing, and destructive inflammatory disorder of the colon that can lead to significant organ damage and severely impair quality of life. A “treat-to-target” approach, involving tight monitoring of intestinal inflammation, is recommended to manage UC effectively. Colonoscopy (CS) is currently the gold standard for assessing disease activity and treatment response. However, it is an invasive and often unpleasant procedure with inherent risks, especially during severe disease flares. Intestinal ultrasound (IUS) offers a patient-friendly, non-invasive, accurate, and cost-effective alternative for managing UC in clinical practice. Its utility as a point-of-care tool can significantly increase the frequency of treatment assessments, thereby accelerating clinical decision-making processes. Recently, intestinal ultrasound (IUS) has proven to be an accurate tool for monitoring treatment response in ulcerative colitis (UC) (Maaser C, Petersen F, Helwig U, Fischer I, Roessler A, Rath S, et al. Gut 69(9):1629–1636, 2020). We have externally validated the Milan ultrasound criteria (MUC) for non-invasive ultrasonographic assessment and grading of endoscopic activity in UC (Allocca M, Fiorino G, Bonovas S, Furfaro F, Gilardi D, Argollo M, et al. J Crohns Colitis 12(12):1385–1391, 2018; Allocca M, Filippi E, Costantino A, Bonovas S, Fiorino G, Furfaro F, et al. United Eur Gastroenterol J 9(4):438–442, 2021). The MUC is calculated using the formula: 1.4 × bowel wall thickness (BWT, mm) + 2 × color Doppler signals (CDS; 1 if present, 0 if absent). The most accurate cutoff values for MUC are: A decrease of 2 points in the MUC is predictive of long-term endoscopic response. Notably, an MUC < 6.2 at week 12 after biologic induction therapy has a negative predictive value (NPV) of 96% for endoscopic remission at reassessment. This allows for early adjustment of treatment if the early ultrasound target has not been met (Allocca M, Dell’avalle C, Furfaro F, Zilli A, D’amico F, Peyrin-Biroulet L, et al. J Crohns Colitis 17(10):1579–1586, 2023). Additionally, the MUC has demonstrated superior predictive value for colectomy risk compared to the MES, with an optimal cutoff value of 7.7 (Allocca M, Dell’Avalle C, Craviotto V, Furfaro F, Zilli A, D’Amico F, et al. United Eur Gastroenterol J 10(2):190–197, 2022; Sed NPO, Noviello D, Filippi E, Conforti F, Furfaro F, Fraquelli M, et al. J Crohns Colitis 18(2):291–299, 2024).

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Role of Intestinal Ultrasound in Assessing Disease Activity and in Evaluating the Response to Treatment in Ulcerative Colitis

  • 章节

  • 发表日期：

    2026年

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  • Mariangela Allocca,
  • Alessandra Zilli,
  • Federica Furfaro

摘要

Ulcerative colitis (UC) is a chronic, relapsing, and destructive inflammatory disorder of the colon that can lead to significant organ damage and severely impair quality of life. A “treat-to-target” approach, involving tight monitoring of intestinal inflammation, is recommended to manage UC effectively. Colonoscopy (CS) is currently the gold standard for assessing disease activity and treatment response. However, it is an invasive and often unpleasant procedure with inherent risks, especially during severe disease flares. Intestinal ultrasound (IUS) offers a patient-friendly, non-invasive, accurate, and cost-effective alternative for managing UC in clinical practice. Its utility as a point-of-care tool can significantly increase the frequency of treatment assessments, thereby accelerating clinical decision-making processes. Recently, intestinal ultrasound (IUS) has proven to be an accurate tool for monitoring treatment response in ulcerative colitis (UC) (Maaser C, Petersen F, Helwig U, Fischer I, Roessler A, Rath S, et al. Gut 69(9):1629–1636, 2020). We have externally validated the Milan ultrasound criteria (MUC) for non-invasive ultrasonographic assessment and grading of endoscopic activity in UC (Allocca M, Fiorino G, Bonovas S, Furfaro F, Gilardi D, Argollo M, et al. J Crohns Colitis 12(12):1385–1391, 2018; Allocca M, Filippi E, Costantino A, Bonovas S, Fiorino G, Furfaro F, et al. United Eur Gastroenterol J 9(4):438–442, 2021). The MUC is calculated using the formula: 1.4 × bowel wall thickness (BWT, mm) + 2 × color Doppler signals (CDS; 1 if present, 0 if absent). The most accurate cutoff values for MUC are: A decrease of 2 points in the MUC is predictive of long-term endoscopic response. Notably, an MUC < 6.2 at week 12 after biologic induction therapy has a negative predictive value (NPV) of 96% for endoscopic remission at reassessment. This allows for early adjustment of treatment if the early ultrasound target has not been met (Allocca M, Dell’avalle C, Furfaro F, Zilli A, D’amico F, Peyrin-Biroulet L, et al. J Crohns Colitis 17(10):1579–1586, 2023). Additionally, the MUC has demonstrated superior predictive value for colectomy risk compared to the MES, with an optimal cutoff value of 7.7 (Allocca M, Dell’Avalle C, Craviotto V, Furfaro F, Zilli A, D’Amico F, et al. United Eur Gastroenterol J 10(2):190–197, 2022; Sed NPO, Noviello D, Filippi E, Conforti F, Furfaro F, Fraquelli M, et al. J Crohns Colitis 18(2):291–299, 2024).