Early Transabdominal Ultrasound Evaluation Can Predict Clinical Response to Therapy in Patients with Active Ulcerative Colitis

Abstract

Purpose: CONTEXT: Lack of objective measures to evaluate response to initial treatment of active ulcerative colitis frequently causes delay in modification of treatment. Transabdominal ultrasound (TAUS) is a convenient noninvasive procedure and measured bowel wall thickness is known to correlate with degree of inflammation. However, whether findings on TAUS in early phase of treatment can predict outcome of active ulcerative colitis has not been determined. QUESTION: Can TAUS measurement of bowel wall thickness predict outcome of patients with active ulcerative colitis? Methods: Design: Prospective analysis of a cohort followed for 8 weeks. Setting: Primary and referral center of a hospital in urban area in Japan. Patients: Twelve patients with active ulcerative colitis who received usual pharmacological therapy as well as cytapheresis. Mean UC-DAI score was 9.8 before enrollment. Prognostic factor: Total colonic wall thickness and submucosal thickness measured by TAUS performed at 2 to 3 weeks after initiation of the treatment. Outcomes: UC-DAI score measured at 8 weeks after initiation of treatment. Score less than 4 defined as response to treatment. Results: MAIN RESULTS: Total colonic wall thickness adjusted by body surface areas (1.8 vs. 2.9 mm) and submucosal thickness (1.3 vs. 2.2 mm) were significantly lower in a group of 7 responders, compared to a group of 5 non-responders (P < 0.05). LIMITATIONS: The trial size was small, and blinded evaluation was not done. Conclusion: Early application of TAUS may predict clinical response later in the course of therapy in patients with active ulcerative colitis.