Accuracy of Humanitas Ultrasound Criteria in assessing disease activity and severity in ulcerative colitis: a prospective study.
J Crohns Colitis. 2018 Aug 04;:
Authors: Allocca M, Fiorino G, Bonovas S, Furfaro F, Gilardi D, Argollo M, Magnoni P, Peyrin-Biroulet L, Danese S
Background: Colonoscopy (CS) is the standard for assessing disease activity in ulcerative colitis (UC), although invasive and poorly tolerated. Bowel ultrasound (BUS) may be a valid alternative in UC patients, however the comparative accuracy between BUS and CS is unknown.
Methods: Consecutive patients with UC were prospectively assessed by CS and BUS. Colonic wall thickening (CWT >3 mm), colonic wall flow at Power Doppler (CWF), colonic wall pattern (CWP) and presence of lymph nodes evaluated at BUS were compared with CS. The endoscopic activity was assessed according to the Mayo endoscopic sub-score (0-3). All BUS were performed by two independent gastroenterologists and Kappa statistic for agreement was calculated. Ultrasonography-based criteria (Humanitas Ultrasound Criteria (HUC) were developed.
Results: Fifty-three UC patients (56% with left-sided colitis, 19% with pancolitis) were prospectively enrolled. 22 patients had mucosal healing (Mayo endoscopic sub-score 0-1), 31 patients were in endoscopic activity. CWT, CWF, hypoechogenic CWP and the presence of lymph nodes significantly correlated with endoscopic activity (p< 0.05). CWT (p= 0.01) and CWF (p= 0.09) were independent predictors for endoscopic activity. The HUC developed are: (i) the presence of a CWF, and CWT > 3 mm, or (ii) the absence of a CWF, and CWT > 4.43 mm. They showed high accuracy for the detection of disease activity (sensitivity 0.71, specificity 1.00). The interobserver agreements for BUS was excellent (kappa 0.86).
Conclusions: BUS is a non-invasive, easy-to-use tool to manage UC patients in clinical practice. HUC were very accurate in assessing disease activity in UC patients.
PMID: 30085066 [PubMed – as supplied by publisher]