Detection of Extraintestinal and Intestinal Abnormalities in Inflammatory Bowel Disease by Ultrasound

Abstract

Abdominal ultrasound (US) can detect extraintestinal and intestinal manifestations and complications of Crohn’s disease. However, the clinical value of routine examination of all patients with inflammatory bowel disease is not known. A total of 100 patients (70% outpatients) with inflammatory bowel disease – 74 Crohn’s disease (CD) and 26 ulcerative colitis (UC) – was studied by US without knowledge of clinical or laboratory data except the diagnosis of inflammatory bowel disease. 39% of the patients with CD showed intestinal abnormalities (target sign: 18%, bowel conglomerates 5%, bowel wall diameter > 5 mm: 20%, prestenotic dilatation: 1%), while 35% of patients with UC had such abnormalities (19% target sign and 27% increased bowel wall diameter). Gallstones were found in 12% of patients with CD and 4% of those with UC. Cholecystectomy had been performed in 7 and 4%, respectively. Renal stones were found in 4 and 8%, liver abnormalities in 19% of both patient groups. Overall, in 30 and 27% at least one extraintestinal abnormality was seen. No clear correlation of disease activity with the occurrence of intestinal or extraintestinal findings was found in CD while bowel abnormalities were more likely to be detected in patients with active UC. None of the laboratory parameters assessed predicted the finding of gallstones, renal stones or liver abnormalities. Renal stones occurred more often in patients with ileal resection and longer duration of disease. US was found to be useful in the routine investigation of patients with inflammatory bowel disease since it detects a considerable number of extraintestinal complications. In addition, it can demonstrate intestinal abnormalities and complications and might be an additional noninvasive method to assess disease activity in UC.