Intestinal ultrasound offers new approach to monitoring inflammatory bowel disease

Ultrasound image of the sigmoid colon

MUSC Children’s Health offers intestinal ultrasound as part of a pilot initiative while its physicians complete their training

by Renee Lemley

When Carmine Suppa, D.O., the director of pediatric inflammatory bowel disease at MUSC Children’s Health, meets with a pediatric gastroenterology patient, he has a new modality to offer that brings a smile to everyone’s face.

Suppa is one of a small group of pediatric gastroenterologists in the country who are trained to use intestinal ultrasound (IUS) for patients in need of an assessment or monitoring of inflammatory bowel disease and other gastroenterological disorders, such as Crohn’s disease and ulcerative colitis.

“It’s currently the best noninvasive and cost-effective way to get live imaging of the lower GI tract that accurately detects disease activity,” says Suppa. “Patients are happier because it’s quick, painless, easy, and an inclusive experience while it gives physicians real-time feedback on treatment efficacy.”

Intestinal ultrasound

Ultrasound is commonly used in many health care applications to provide visibility to tissues, organs, blood vessels and more to assist physicians in assessing, monitoring and diagnosing. What is relatively new in the United States is the use of ultrasound for inflammatory bowel disease (IBD).

IUS is essentially an abdominal ultrasound that provides highly accurate, high-resolution imaging of the intestine and colon. It does not require any of the more intensive bowel preparation needed for invasive procedures like colonoscopies, and it does not have any side effects like those that might occur from radiation.

Unlike other imaging modalities, such as CT and MRI, gastrointestinal ultrasound is inexpensive and can be used at the point of care to enable physicians to make immediate decisions about a diagnosis, treatment or the need for further testing.

IUS allows visibility of both the large intestine (colon) and the small intestine (terminal ileum), and disease activity can be assessed using several markers, such as bowel wall thickness, hyperemia (increased blood flow) and disruption of wall layers.

“With IUS, I’m able to see how thick the bowel wall is and if there is an increased blood flow to that area, which would indicate inflammation,” explains Suppa. “I can also see if there is any disruption to the layers of the bowel wall or signs of complications such as strictures.” This allows him to determine how well a patient is responding to a prescribed treatment without waiting for lab results or the need to schedule other procedures or imaging.

Benefits to patients

IUS is one of the most patient-centered monitoring techniques available. Patients love it for all the same reasons their doctors do.

IUS includes the following benefits:

  • Painless, noninvasive, cost-effective, more efficient than invasive modalities

  • Fastest way to determine treatment responsiveness and/or reaction to medications

  • Provides imaging map of GI system that gives real-time feedback with no side effects

  • Life-changing option for people who need an annual colonoscopy

  • Educational tool that improves patient understanding of their condition/disease

Most importantly, patient satisfaction has gone up. Since patients are awake and aware during the examination, they get real-time insight into what’s happening and immediate feedback from their doctor. They’re actively engaged with the IUS, quality visuals, and their clinician so they’re learning more about their conditions without any accompanying physical discomfort. It’s a win-win.

Training needs and opportunities

IUS has been widely adopted in Europe and Canada as the standard for point of care, but its uptake has been slow in the United States, primarily because of a lack of training opportunities. It also takes time for physicians to reach proficiency in performance and appropriate assessment of the images. In U.S. medical training, there isn’t as much training around ultrasound – let alone GI ultrasound – as there is abroad. Additionally, structured training for gastroenterologists has previously only been available outside the U.S.

“That’s all changing, and it’s changing fast,” Suppa said. “It’s only a matter of time before IUS for IBD monitoring becomes the standard in U.S. IBD centers.”

Ben Kuhn, D.O., chief of the Division of Pediatric Gastroenterology, adds, “MUSC is among the earliest adopters in the country of this critically needed tool for the better management of inflammatory bowel disease. Over the past year, Suppa has devoted himself to gaining his formal IUS certification so that we can further expand the capabilities and services we offer to our patients in this region.”

Right now, MUSC Children’s Health is offering IUS as part of a pilot initiative while its physicians are completing their training. There aren’t many other places in the country that pediatric patients can go for this kind of care.

The International Bowel Ultrasound Society (IBUS), based in Germany, has set up a 3-module training program for IUS certification. The program is lecture based and requires 40 hours of hands-on ultrasound sessions with an expert over the course of four weeks. The training is then followed by a practical exam.

Per the IBUS website, the program is designed to be completed within two years. Additionally, beyond the certification program, there are interactive webinars where anyone can learn more.

“Through IBUS, there’s a pathway to learn how to bring this to your center,” says Suppa. “IBD care continues to move towards precision monitoring and proactive decision making. It is our obligation as providers to continue to move the needle when it comes to incorporating advancing technology to improve patient experience, understanding, care and outcomes.”