P641 Bowel Doppler Signal, the most important ultrasonographic feature in clinical practice in managing Inflammatory Bowel Diseases patients
Les, A.(1)*;Cotruta, B.(1);Iacob , R.(1,2);Saizu, R.(1,2);Gheorghe, L.(1,2);Gheorghe, C.(1,2);
(1)Fundeni Clinical institute, Gastroenterology, Bucharest, Romania;(2)“Carol-Davila” University of Medicine and Pharmacy, Gastroenterology, Bucharest, Romania;
Background
IBD are chronic diseases that require multiple endoscopic and imaging assessments, being diseases that not only involve a multitude of medical resources but patient compliance too. Bowel ultrasound (BUS) is a useful imaging tool in monitoring inflammatory bowel diseases (IBD) patients. Current guidelines recommend BUS altogether with other cross-sectional imaging methods to diagnose, monitor IBD patients and also for detecting complications and post-surgery recurrence. A multitude of ultrasonographic features are used to describe pathologic findings related to IBD but not all of them are easy to integrate in clinical practice, especially in unexperienced hands.
Methods
Our study included 117 IBD patients of which 28 were diagnosed with ulcerative colitis and 89 with Crohn’s disease. Diagnosis was established endoscopically and histologically and both patients with active and inactive disease were included. Exclusion criteria consisted in patients with other causes of inflammatory syndrome, patients with solely rectal localization of the disease or a surgical history. Subjects were prospectively evaluated using BUS and several sonographic aspects of the bowel wall were monitored: bowel wall thickness, bowel echo pattern, Doppler signal (DS) presence, hypertrophic mesenteric fat, and the presence of lymph nodes. Biological markers of inflammation were obtained including faecal calprotectin. Patients were followed up for the next 6 months and data regarding treatment intensification was noted. All patients signed an informed consent, and the study was approved by the Ethics Committee of the Fundeni Clinical Institute.
Results
Significantly higher values of clinical and biological markers were associated with the presence of parietal DS (p<0.0001) suggesting that this BUS feature is an important bowel wall inflammation surrogate. Higher Limberg scores (a subjective Doppler signal score used in BUS) correlated with increased values of biological markers of inflammation (p=0.002). A multivariate analysis showed that DS and a thicker than 5 mm bowel wall were independent predictors of step-up therapy. The presence of parietal DS raised the patient risk of switching therapy 7.6 times, while bowel wall thickness only 2.4 times, making DS the most useful BUS feature in evaluating inflammatory activity and predicting the need for step-up therapy.
Conclusion
DS is one of the most important BUS features to use in evaluating and monitoring IBD patients and could have a role in disease decision making. This finding should advocate for this imaging method in clinical practice, and even low BUS-experience practitioners are encouraged to use it.