P0453 Intestinal Ultrasound Correlates with Patient-Reported IBD Disability in Ulcerative Colitis: A Step Towards Integrated Monitoring

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Abstract Background Non-invasive imaging methods, particularly intestinal ultrasound (IUS), are increasingly pivotal in guiding management in ulcerative colitis (UC). While long-term treatment goals focus on reducing IBD-related disability, the link between ultrasonographic findings and patient-reported outcome measures (PROMs), such as IBD-related disability, remains unclear. Methods Data on IBD-related disability (using the IBD disk) were prospectively gathered through a digital questionnaire from patients with UC undergoing routine IUS, and performed within maximal one week of each other. Patients with isolated proctitis were excluded. Bowel wall thickness (BWT) was averaged from two independent measurements >1 cm apart, alongside colour Doppler assessments, all blinded to IBD disk data. The Milan Ultrasound Criteria (MUC) score was calculated, with relevant ultrasound activity defined as MUC >6.2 (worst affected segment).1 A high IBD-related burden was defined as an IBD disk score >40. Correlation analysis was performed using Spearman’s rank coefficient. Results Thirty-one paired assessments (median interval: 0.0 [IQR 0.0–3.0] days) were conducted on unique UC patients (38.7% female, median age 32.6 [28.0–45.9] years, median disease duration 1.3 [0.3–6.6] years, 71.0% left-sided colitis). Ultrasound activity (MUC >6.2) was present in 51.6% of patients, while 29.0% reported a high IBD-related disability. Total IBD disk scores correlated significantly with maximal BWT (r=0.41, p=0.02), modified Limberg Doppler signal (r=0.35, p=0.05), and MUC scores (r=0.44, p=0.01). Patients without MUC-defined inflammation showed significantly lower IBD-related disability (median IBD disk score: 41.0 [26.0–52.0]) compared to those with inflammation (72.0 [58.0–78.0], p=0.001) (Figure 1A). Individual IBD disk components—abdominal pain, body image, education/work impact, emotions, energy, interpersonal interactions, defecation regulation, sexual function, and sleep—differed significantly between patients with and without ultrasonographic inflammation (Table 1). Quartile analysis revealed that normal ultrasonographic findings were most likely in patients with the lowest IBD disk scores (Q1 vs Q2–Q4: 87.5% vs 53.3%, p=0.02) (Figure 1B). Receiver Operating Characteristic (ROC) analysis suggested a stricter MUC cutoff of 5.3, achieving 71.0% [48.1–93.8%] accuracy in estimating IBD-related disability with a negative predictive value of 88.2%. Conclusion In patients with UC, IUS findings correlate with IBD-related disability and warrant further exploration as potential endpoint and/or treatment target. However, these metrics seem complementary rather than fully interchangeable.