Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands.
Paediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Inflamm Bowel Dis. 2024 Nov 4;30(11):1992-2003. doi: 10.1093/ibd/izad274.
Intestinal ultrasound (IUS) is an emerging modality in monitoring disease activity in ulcerative colitis (UC). Here, we aimed to identify early IUS predictors of treatment response as evaluated by endoscopy and assessed the kinetics of IUS changes.
This prospective, longitudinal study included UC patients with endoscopic disease activity (endoscopic Mayo score [EMS] ≥2) starting anti-inflammatory treatment. Clinical scores, biochemical parameters and IUS were assessed at baseline (W0), at week 2 (W2), at W6(W6), and at the time of second endoscopy (W8-W26). Per colonic segment, endoscopic remission (EMS = 0), improvement (EMS ≤1), response (decrease in EMS ≥1), and clinical remission (Lichtiger score ≤3) were assessed and correlated with common IUS parameters. Additionally, drug-specific responsiveness of bowel wall thickness (BWT) was assessed.
A total of 51 patients were included and followed, and 33 patients underwent second endoscopy. BWT was lower from W6 onward for patients reaching endoscopic improvement (3.0 ± 1.2 mm vs 4.1 ± 1.3 mm; P = .026), remission (2.5 ± 1.2 mm vs 4.1 ± 1.1 mm; P = .002), and clinical remission (3.01 ± 1.34 mm vs 3.85 ± 1.20 mm; P = .035). Decrease in BWT was more pronounced in endoscopic responders (-40 ± 25% vs -4 ± 28%; P = .001) at W8 to W26. At W6, BWT ≤3.0 mm (odds ratio [OR], 25.13; 95% confidence interval, 2.01-3.14; P = .012) and color Doppler signal (OR, 0.35; 95% confidence interval, 0.14-0.88; P = .026) predicted endoscopic remission and improvement, respectively. Submucosal layer thickness at W6 predicted endoscopic remission (OR, 0.09; P = .018) and improvement (OR, 0.14; P = .02). Furthermore, BWT decreased significantly at W2 for infliximab and tofacitinib and at W6 for vedolizumab.
BWT and color Doppler signal predicted endoscopic targets already after 6 weeks of treatment and response was drug specific. IUS allows close monitoring of treatment in UC and is a surrogate marker of endoscopy.
肠道超声（IUS）是监测溃疡性结肠炎（UC）疾病活动的新兴方法。在这里，我们旨在确定通过内镜评估治疗反应的早期 IUS 预测因子，并评估 IUS 变化的动力学。
这项前瞻性、纵向研究纳入了内镜疾病活动（内镜 Mayo 评分[EMS]≥2）开始接受抗炎治疗的 UC 患者。在基线（W0）、第 2 周（W2）、第 6 周（W6）和第 2 次内镜检查时（W8-W26）评估临床评分、生化参数和 IUS。按结肠段评估内镜缓解（EMS=0）、改善（EMS≤1）、反应（EMS 降低≥1）和临床缓解（Lichtiger 评分≤3），并与常见 IUS 参数相关联。此外，评估了肠壁厚度（BWT）对药物的特异性反应。
共纳入 51 例患者并进行随访，其中 33 例患者进行了第 2 次内镜检查。从第 6 周开始，达到内镜改善（3.0±1.2 mm 比 4.1±1.3 mm；P=0.026）、缓解（2.5±1.2 mm 比 4.1±1.1 mm；P=0.002）和临床缓解（3.01±1.34 mm 比 3.85±1.20 mm；P=0.035）的患者的 BWT 更低。第 8 至 26 周时，内镜反应者的 BWT 下降更明显（-40±25%比-4±28%；P=0.001）。在第 6 周时，BWT≤3.0 mm（比值比[OR]，25.13；95%置信区间，2.01-3.14；P=0.012）和彩色多普勒信号（OR，0.35；95%置信区间，0.14-0.88；P=0.026）分别预测内镜缓解和改善。第 6 周时黏膜下层厚度预测内镜缓解（OR，0.09；P=0.018）和改善（OR，0.14；P=0.02）。此外，英夫利昔单抗和托法替布在第 2 周、vedolizumab 在第 6 周时 BWT 显著下降。
BWT 和彩色多普勒信号在治疗后 6 周即可预测内镜目标，且反应具有药物特异性。IUS 允许对 UC 的治疗进行密切监测，是内镜的替代标志物。
