Exabis Library

The disease course of inflammatory bowel disease (IBD) is heterogeneous and highly unpredictable. Intestinal Ultrasound (IUS) is a non-invasive modality capable of assessing disease activity in IBD. IUS is reliable, patient-friendly, and allows frequent monitoring of disease activity. However, the evidence for IUS as a predictor of disease course is still limited. Here we present novel data on the predictive value of IUS performed at the time of IBD diagnosis.

Patients with new-onset IBD are currently being included in the ongoing multicentre prospective inception cohort study, the IBD Prognosis Study. During the first five years following diagnosis, patients undergo regular clinical, biochemical, endoscopic, and imaging assessments. IBD treatment and disease events are prospectively recorded. IUS is performed at diagnosis, after three months, and hereafter annually. Patients with proctitis do not undergo assessment with IUS. The newly developed IUS score, the International Bowel Ultrasound Segmental Activity Score (IBUS-SAS), is calculated for the most inflamed segment, with a high score indicating severe disease activity. The score incorporates bowel wall thickness (BWT), bowel wall stratification, colour Doppler signal, and inflammatory fat. In this abstract, we report our preliminary results after including patients for six months.

IBUS-SAS at diagnosis was available in 60 patients. 32 patients were diagnosed with Crohn’s disease (ilieal: 7, colonic: 19, ileocolonic: 6) and 28 patients were diagnosed with ulcerative colitis (UC) or unclassified IBD (proctitis: 1, left-sided colitis: 8, extensive colitis: 19). The mean IBUS-SAS at diagnosis was 51.1, with a mean BWT of 5.2 mm. Major clinical outcomes were initiation of biologic therapy, n=12 (20.0%), IBD-related bowel resection, n=5 (8.3%), IBD-related hospitalisation, n=19 (31.7%). The mean IBUS-SAS at diagnosis was 66.2 among patients with the combined endpoint of any of these disease outcomes during follow-up vs. 34.7 for no major outcomes (p<0.001), see Figure 1. Additionally, we found that all patients with an IBUS-SAS above 80 at diagnosis had been hospitalised and started on systemic steroids. So far, 20 patients had an IUS follow-up scan after three months showing a mean IBUS-SAS reduction by 17.0 points (p=0.008).

We present data on the predictive value of early IUS in new-onset IBD.  IUS activity at diagnosis of IBD seems to have the capability to predict short term disease outcome. At diagnosis, high IBUS-SAS is associated with major disease events such as starting biological therapy, IBD-related bowel resection, and IBD-related hospitalisation. Furthermore, response to treatment is reflected by a decrease in IBUS-SAS after three months.

Fascinating results from Nadia Pillai, using real world data from a Swiss IBD cohort to model the cost-effectiveness of early biologic therapy. Early use of biologics is not cost effective in this cohort, but this outcome changes with biologic price drops or with more careful patient selection.

The talk will show important ultrasound differential diagnosis in IBD 

Educational objectives:

1. Identify casual roles for diet in developing IBD.
2. Present research on how having IBD might impact diet.
3. Discuss ways to separate these effects in order to improve diet management for IBD patients.

Summary:

The link between diet and IBD is well-established. Most of the focus, especially over the last few years, has been on how diet might lead to or trigger the development of IBD, and use of diet as a therapy, especially in shown for paediatric Crohn disease.  Both epidemiologic research and animal/mechanistic studies support beneficial (e.g., fruits and vegetables) and detrimental (e.g., processed foods) roles of foods in developing IBD. However, having IBD certainly impacts one’s diet; this could include avoidance of food overall, foods that increase symptoms, or following advice from clinicians. This bidirectional relationship complicates our ability to understand the relationship between diet and IBD and guide patient care.

In this presentation I will discuss this topic and offer ways to better define the link between diet and IBD. There are certainly misconceptions and confusing messages related to diet management for IBD patients as a result of this 2-way relationship. It is important for both dietitians and those involved in diet research in IBD to be aware of these factors and find ways to improve diet research and patient care.

Learning Objectives:
1.  Drug safety at conception and during pregnancy
2. Management of disease exacerbation during pregnancy, assessment and therapeutic options
3. Management of biologics during pregnancy and post-partum 

Educational objectives:
To understand what´s new on the use of IUS in CD regarding the following aspects:
- outcome studies
- activity and fibrosis score
- perineal ultrasound

Educational Objectives:
1. To review the settings in ulcerative colitis (UC) where intestinal ultrasound (IUS) can be used.
2. To review the role of IUS in the management of patients suspected to have UC.
3. To emphasise the important role of IUS as a tool to assess disease activity, severity and extension in UC.
4. To emphasise the important role of IUS as a monitoring tool to assess response to therapy in UC.
5. To have an overview of the existing IUS scores in UC and their applicability.
6. To review potential complications in UC and the role of IUS in predicting surgery.
7. To have an overview of the burning and open questions regarding IUS in UC in 2021.