P357 Intestinal ultrasound as a promising non-invasive monitoring tool in patients with Ulcerative Colitis

Morão, B.(1)*;Nascimento, C.(1);Revés, J.(1);Abreu, B.(1);Bravo, A.C.(1);Saraiva, S.(1);Glória, L.(1);Torres, J.(1);Palmela, C.(1);Frias Gomes, C.(1);

(1)Hospital Beatriz Ângelo, Gastroenterology, Lisbon, Portugal;


Intestinal ultrasound (IUS) is an established non-invasive tool for monitoring disease activity in Crohn’s disease, however its value in ulcerative colitis (UC) is still less clear. Our goal was to correlate IUS features with well-established disease targets in UC. 


Prospective study including patients with left-sided (E2) or extensive (E3) UC. Simple Clinical Colitis Activity Index (SCCAI), patient reported outcomes (PRO-2), C-reactive protein (CRP), fecal calprotectin (FCal) and endoscopic activity (Mayo endoscopic subscore - sMayo) were evaluated. IUS features included bowel wall thickness (BWT) and color Doppler flow (CDF), assessed by modified Limberg score. The most affected segment was selected for analysis. Clinical remission was defined by SCAAI ≤ 2, endoscopic remission by sMayo of 0 and IUS remission by BWT ≤ 3 mm and CDF=0. 


17 UC patients (59% males, median age 44 (20-68) years, 53% E3) were included and evaluated in 46 different time-points, with concomitant endoscopic assessment in 31 cases. Overall, 55% were in clinical remission, 30% in endoscopic remission and 22% in IUS remission. The sigmoid colon was the most affect segment by IUS (46%) and endoscopy (39%). Median BWT in the most affected segment was 4.28 (3.08-6.25) mm and 83% had a Limberg score ≥ 1. Median CRP was 0.41 (0.06-18.55) mg/dL and FCal 80 (3-8000) ug/g. There was a moderate agreement between IUS and endoscopy regarding the most affected segment (k=0.43, p<0.001). BWT showed a strong correlation with sMayo and CRP and a moderate correlation with FCal, SCCAI and PRO-2. CDF showed no significant correlations with clinical, biochemical and endoscopic features (Table 1). Patients with IUS remission presented higher rates of endoscopic remission (78% vs 10%, p<0.001) and lower sMayo scores (0 vs 2, p<0.001), together with lower FCal (21 vs 133 ug/g, p=0.01) and CRP levels (0.08 vs 0.54, p<0.01).


IUS features showed a significant correlation with endoscopic activity, clinical activity and biomarkers. IUS remission was associated with endoscopic remission and lower biomarker activity, suggesting that IUS is an accurate method to evaluate UC patients both with active disease and in remission.