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Usefulness of transabdominal ultrasonography for assessing ulcerative colitis: a prospective, multicenter study

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Abstract

Background

Transabdominal ultrasonography (US) has been reported to be a useful tool for evaluating ulcerative colitis (UC) although with less well-established data than for Crohn’s disease. This prospective multicenter study aimed to establish the usefulness of US compared with colonoscopy (CS) for assessing disease extent and activity of UC.

Methods

Altogether, 173 patients with UC were prospectively enrolled, among whom 156 were eligible for this study. All patients underwent US and CS within 2 days at five facilities. We divided the colon into six segments and examined each segment and the rectum using US and CS. US severity was graded 1–4 regarding bowel wall thickness, stratification, and ulceration. CS severity was also graded 1–4 according to Matts’ endoscopic classification. Concordance between US and CS grades for all colonic segments was analyzed using kappa statistics. US and CS findings were also compared with the clinical disease activity index (CAI) and histological grade using Spearman's correlation coefficient.

Results

There was moderate concordance between US and CS grades in all colonic segments (weighted κ = 0.55, p < 0.001). Concordance was rated moderate for each colonic segment but only slight for the rectum. The US grade was significantly correlated with the CAI score (r = 0.40, p < 0.001) and histological grade (r = 0.35, p < 0.001).

Conclusions

This prospective multicenter study showed moderate concordance between US and CS for assessing the disease activity of UC. Hence, US may be used more generally for evaluating UC in daily clinical practice.

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References

  1. Danese S, Fiocchi C. Ulcerative colitis. N Engl J Med. 2011;365:1713–25.

    Article  CAS  PubMed  Google Scholar 

  2. Ordás I, Eckmann L, Talamini M, et al. Ulcerative colitis. Lancet. 2012;380:1606–19.

    Article  PubMed  Google Scholar 

  3. Dignass A, Lindsay JO, Sturm A, et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 2: current management. J Crohns Colitis. 2012;6:991–1030.

    Article  PubMed  Google Scholar 

  4. Damore LJ II, Rantis PC, Vernava AM III, et al. Colonoscopic perforations. Etiology, diagnosis, and management. Dis Colon Rectum. 1996;39:1308–14.

    Article  PubMed  Google Scholar 

  5. Levin TR, Conell C, Shapiro JA, et al. Complications of screening flexible sigmoidoscopy. Gastroenterology. 2002;123:1786–92.

    Article  PubMed  Google Scholar 

  6. Peloquin JM, Pardi DS, Sandborn WJ, et al. Diagnostic ionizing radiation exposure in a population-based cohort of patients with inflammatory bowel disease. Am J Gastroenterol. 2008;103:2015–22.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Jaffe TA, Gaca AM, Delaney S, et al. Radiation doses from small-bowel follow-through and abdominopelvic MDCT in Crohn's disease. Am J Roentgenol. 2007;189:1015–22.

    Article  Google Scholar 

  8. Ajaj WM, Lauenstein TC, Pelster G, et al. Magnetic resonance colonography for the detection of inflammatory diseases of the large bowel: quantifying the inflammatory activity. Gut. 2005;54:257–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Ordas I, Rimola J, Garcia-Bosch O, et al. Diagnostic accuracy of magnetic resonance colonography for the evaluation of disease activity and severity in ulcerative colitis: a prospective study. Gut. 2013;62:1566–72.

    Article  PubMed  Google Scholar 

  10. Horsthuis K, Bipat S, Bennink RJ, et al. Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies. Radiology. 2008;247:64–79.

    Article  PubMed  Google Scholar 

  11. Hata J, Haruma K, Suenaga K, et al. Ultrasonographic assessment of inflammatory bowel disease. Am J Gastroenterol. 1992;87:443–7.

    CAS  PubMed  Google Scholar 

  12. Parente F, Greco S, Molteni M, et al. Imaging inflammatory bowel disease using bowel ultrasound. Eur J Gastroenterol Hepatol. 2005;17:283–91.

    Article  PubMed  Google Scholar 

  13. Calabrese E, Maaser C, Zorzi F, et al. Bowel ultrasonography in the management of Crohn's disease. A review with recommendations of an international panel of experts. Inflamm Bowel Dis. 2016;22:1168–83.

    Article  PubMed  Google Scholar 

  14. Migaleddu V, Quaia E, Scano D, et al. Inflammatory activity in Crohn disease: ultrasound findings. Abdom Imaging. 2008;33:589–97.

    Article  PubMed  Google Scholar 

  15. Fraquelli M, Sarno A, Girelli C, et al. Reproducibility of bowel ultrasonography in the evaluation of Crohn's disease. Dig Liver Dis. 2008;40:860–6.

    Article  CAS  PubMed  Google Scholar 

  16. Parente F, Maconi G, Bollani S, et al. Bowel ultrasound in assessment of Crohn's disease and detection of related small bowel strictures: a prospective comparative study versus X-ray and intraoperative findings. Gut. 2002;50:490–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Parente F, Greco S, Molteni M, et al. Oral contrast enhanced bowel ultrasonography in the assessment of small intestine Crohn's disease. A prospective comparison with conventional ultrasound, X-ray studies, and ileocolonoscopy. Gut. 2004;53:1652–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Dietrich CF. Significance of abdominal ultrasound in inflammatory bowel disease. Dig Dis. 2009;27:482–93.

    Article  CAS  PubMed  Google Scholar 

  19. Martinez MJ, Ripolles T, Paredes JM, et al. Assessment of the extension and the inflammatory activity in Crohn's disease: comparison of ultrasound and MRI. Abdom Imaging. 2009;34:141–8.

    Article  PubMed  Google Scholar 

  20. Civitelli F, Di Nardo G, Oliva S, et al. Ultrasonography of the colon in pediatric ulcerative colitis: a prospective, blind, comparative study with colonoscopy. J Pediatr. 2014;165(78–84):e2.

    Google Scholar 

  21. Parente F, Molteni M, Marino B, et al. Are colonoscopy and bowel ultrasound useful for assessing response to short-term therapy and predicting disease outcome of moderate-to-severe forms of ulcerative colitis? A prospective study. Am J Gastroenterol. 2010;105:1150–7.

    Article  PubMed  Google Scholar 

  22. Parente F, Molteni M, Marino B, et al. Bowel ultrasound and mucosal healing in ulcerative colitis. Dig Dis. 2009;27:285–90.

    Article  CAS  PubMed  Google Scholar 

  23. Antonelli E, Giuliano V, Casella G, et al. Ultrasonographic assessment of colonic wall in moderate-severe ulcerative colitis: comparison with endoscopic findings. Dig Liver Dis. 2011;43:703–6.

    Article  PubMed  Google Scholar 

  24. Maconi G, Ardizzone S, Parente F, et al. Ultrasonography in the evaluation of extension, activity, and follow-up of ulcerative colitis. Scand J Gastroenterol. 1999;34:1103–7.

    Article  CAS  PubMed  Google Scholar 

  25. Rachmilewitz D. Coated mesalazine (5-aminosalicylic acid) versus sulphasalazine in the treatment of active ulcerative colitis: a randomised trial. BMJ. 1989;298:82–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Satsangi J, Silverberg MS, Vermeire S, et al. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006;55:749–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Hata J, Haruma K, Yamanaka H, et al. Ultrasonographic evaluation of the bowel wall in inflammatory bowel disease: comparison of in vivo and in vitro studies. Abdom Imaging. 1994;19:395–9.

    Article  CAS  PubMed  Google Scholar 

  28. Wada T, Nishida M, Kudo Y, et al. Comparison between transabdominal ultrasound and colonoscopy in evaluating disease activity of ulcerative colitis (in Japanese). Jpn J Med Ultrasound Technol. 2015;40:141–9.

    Google Scholar 

  29. Matts SG. The value of rectal biopsy in the diagnosis of ulcerative colitis. Q J Med. 1961;30:393–407.

    CAS  PubMed  Google Scholar 

  30. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.

    Article  CAS  PubMed  Google Scholar 

  31. Maconi G. Ultrasonography in the evaluation of extension, activity, and follow-up of ulcerative colitis. Scand J Gastroenterol. 2009;34:1103–7.

    Article  Google Scholar 

  32. Arienti V, Campieri M, Boriani L, et al. Management of severe ulcerative colitis with the help of high resolution ultrasonography. Am J Gastroenterol. 1996;91:2163–9.

    CAS  PubMed  Google Scholar 

  33. Pascu M, Roznowski AB, Muller HP, et al. Clinical relevance of transabdominal ultrasonography and magnetic resonance imaging in patients with inflammatory bowel disease of the terminal ileum and large bowel. Inflamm Bowel Dis. 2004;10:373–82.

    Article  CAS  PubMed  Google Scholar 

  34. Bremner AR, Griffiths M, Argent JD, et al. Sonographic evaluation of inflammatory bowel disease: a prospective, blinded, comparative study. Pediatr Radiol. 2006;36:947–53.

    Article  PubMed  Google Scholar 

  35. Girlich C, Schacherer D, Jung EM, et al. Comparison between quantitative assessment of bowel wall vascularization by contrast-enhanced ultrasound and results of histopathological scoring in ulcerative colitis. Int J Colorectal Dis. 2012;27:193–8.

    Article  PubMed  Google Scholar 

  36. Socaciu M, Ciobanu L, Diaconu B, et al. Non-invasive assessment of inflammation and treatment response in patients with Crohn's disease and ulcerative colitis using contrast-enhanced ultrasonography quantification. J Gastrointest Liver Dis. 2015;24:457–65.

    Google Scholar 

  37. Haber HP, Busch A, Ziebach R, et al. Ultrasonographic findings correspond to clinical, endoscopic, and histologic findings in inflammatory bowel disease and other enterocolitides. Journal of ultrasound in medicine. J Ultrasound Med. 2002;21:375–82.

    Article  PubMed  Google Scholar 

  38. Romanini L, Passamonti M, Navarria M, et al. Quantitative analysis of contrast-enhanced ultrasonography of the bowel wall can predict disease activity in inflammatory bowel disease. Eur J Radiol. 2014;83:1317–23.

    Article  PubMed  Google Scholar 

  39. Baert F, Moortgat L, Van Assche G, et al. Mucosal healing predicts sustained clinical remission in patients with early-stage Crohn's disease. Gastroenterology. 2010;138:463–8 (quiz e10–1).

    Article  PubMed  Google Scholar 

  40. Bryant RV, Burger DC, Delo J, et al. Beyond endoscopic mucosal healing in UC: histological remission better predicts corticosteroid use and hospitalisation over 6 years of follow-up. Gut. 2016;65:408–14.

    Article  CAS  PubMed  Google Scholar 

  41. Walsh A, Palmer R, Travis S. Mucosal healing as a target of therapy for colonic inflammatory bowel disease and methods to score disease activity. Gastrointest Endosc Clin N A. 2014;24:367–78.

    Article  Google Scholar 

  42. Mosli MH, Feagan BG, Sandborn WJ, et al. Histologic evaluation of ulcerative colitis: a systematic review of disease activity indices. Inflamm Bowel Dis. 2014;20:564–75.

    Article  PubMed  Google Scholar 

  43. Parente F, Greco S, Molteni M, et al. Role of early ultrasound in detecting inflammatory intestinal disorders and identifying their anatomical location within the bowel. Aliment Pharmacol Ther. 2003;18:1009–16.

    Article  CAS  PubMed  Google Scholar 

  44. Mak WY, Buisson A, Andersen MJ Jr, et al. Fecal calprotectin in assessing endoscopic and histological remission in patients with ulcerative colitis. Dig Dis Sci. 2018;63:1294–301.

    Article  CAS  PubMed  Google Scholar 

  45. Kopylov U, Rosenfeld G, Bressler B, et al. Clinical utility of fecal biomarkers for the diagnosis and management of inflammatory bowel disease. Inflamm Bowel Dis. 2014;20:742–56.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank all the endoscopists and sonographers who participated in this study. This manuscript has been proofread by Edanz Group (https://www.edanzediting.com/ac).

Funding

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7 Kita-ku, Sapporo, 060-8638, Japan

    Kenji Kinoshita, Takehiko Katsurada, Reizo Onishi & Naoya Sakamoto

  2. Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan

    Mutsumi Nishida & Satomi Omotehara

  3. Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan

    Mutsumi Nishida & Satomi Omotehara

  4. Department of Gastroenterology, National Hospital Organization Hakodate Hospital, Hakodate, Japan

    Katsuhiro Mabe

  5. Department of Clinical Laboratory, Tomakomai City Hospital, Tomakomai, Japan

    Aki Onodera & Mami Sato

  6. Department of Gastroenterology, Tomakomai City Hospital, Tomakomai, Japan

    Kazunori Eto

  7. Department of Clinical Laboratory, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan

    Mitsutoshi Suya

  8. Inflammatory Bowel Disease Center, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan

    Atsuo Maemoto

  9. Department of Clinical Laboratory, Ohguro Gastroenterological Hospital, Sapporo, Japan

    Toru Hasegawa

  10. Ohguro Gastroenterological Hospital, Sapporo, Japan

    Junji Yamamoto

  11. Department of Clinical Laboratory, Sapporo Medical Center NTT EC, Sapporo, Japan

    Daiki Mitsumori

  12. Department of Gastroenterology, Sapporo Medical Center NTT EC, Sapporo, Japan

    Shinji Yoshii

  13. Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan

    Kota Ono

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  1. Kenji Kinoshita
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Correspondence to Kenji Kinoshita.

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Kinoshita, K., Katsurada, T., Nishida, M. et al. Usefulness of transabdominal ultrasonography for assessing ulcerative colitis: a prospective, multicenter study. J Gastroenterol 54, 521–529 (2019). https://doi.org/10.1007/s00535-018-01534-w

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  • DOI: https://doi.org/10.1007/s00535-018-01534-w

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