Michael Dolinger, MD: Recognizing Intestinal Ultrasound’s Potential in Ulcerative Colitis

Findings from a recent study suggest intestinal ultrasound may offer useful predictive capabilities for treat-to-target endoscopic remission in ulcerative colitis (UC), supporting stride II recommendations for early biomarker targets for treatment optimization.

The research was presented at Digestive Disease Week (DDW) 2024 in Washington, DC, this weekend by Michael Dolinger, MD, MBA, assistant professor of pediatric gastroenterology at the Icahn School of Medicine and Mount Sinai Kravis Children's Hospital.

“I think the recognition that ultrasound is a direct monitoring tool of inflammation can really be transformative to how we manage our IBD patients allowing us to see inflammation we weren't detecting before and to optimize treatments before it's too late and they're already in surgery where they have complications,” Dolinger explained to HCPLive.

To evaluate intestinal ultrasound response to predict endoscopic outcomes in children with moderate-to-severe UC, he and a team of investigators conducted a prospective, longitudinal cohort study of children < 18 years of age starting biologic or small molecule treatment (n = 42). Participants were evaluated at baseline, 8+2 weeks, and after 6-12 months at treat-to-target endoscopy by intestinal ultrasound, including bowel wall thickness, color Doppler signal, International Bowel Ultrasound Segmental Activity Score, and Civitelli UC Index, as well as clinical (Pediatric Ulcerative Colitis Activity Index), and biochemical (fecal calprotectin and C-reactive protein) assessments.

Treat-to-target endoscopic remission was defined as an endoscopic Mayo score of 0, endoscopic improvement as an endoscopic Mayo score ≤ 1, and response as an endoscopic Mayo score decrease by ≥ 1. The study’s primary outcome was the accuracy of change in bowel wall thickness between baseline and week 8 to detect endoscopic remission.

In total, 50% of participants achieved endoscopic remission, an additional 21% achieved endoscopic improvement only, and 2% endoscopic response only. Investigators pointed out a ≥ 43% decrease in bowel wall thickness at week 8 predicted endoscopic remission with an AUC of 0.72 (95% CI, 0.56-0.88), endoscopic improvement with an AUC of 0.74 (95% CI, 0.55-0.93), and endoscopic response with an AUC of 0.66 (95% CI, 0.44-0.87).

At week 8, a ≥ 64% decrease in International Bowel Ultrasound Segmental Activity Score had the highest accuracy to detect endoscopic remission (AUC, 0.74; 95% CI, 0.59-0.90), a Civitelli UC Index decrease by ≥ 1 point had the highest accuracy to detect endoscopic improvement (AUC, 0.86; 95% CI, 0.73-0.99), and a ≥ 55% decrease in Pediatric Ulcerative Colitis Activity Index had the highest accuracy to detect endoscopic response (AUC, 0.83; 95% CI, 0.66-0.99). Treat-to-target bowel wall thickness of ≤ 2.2 mm detected endoscopic remission with an AUC of 0.91 (95% CI, 0.82-1.00), 95% sensitivity and 91% specificity. A bowel wall thickness of ≤ 2.8 mm detected endoscopic improvement with an AUC of 1.0.

“What I show in a small cohort of patients that's 42 children is great, but we need that validated in large blinded multicenter studies that we just don't have the capacity to do. We need this research and then we need to show that it actually improves longitudinal outcomes and prevents disease progression, hospitalization, surgery, and complications and that we're actually altering disease natural history,” Dolinger concluded.

Reference:

Dolinger MT, Aronskyy A, Spencer EA, et al. EARLY INTESTINAL ULTRASOUND RESPONSE TO BIOLOGIC AND SMALL MOLECULE THERAPY PREDICTS ENDOSCOPIC OUTCOMES IN CHILDREN WITH ULCERATIVE COLITIS. Abstract presented at Digestive Disease Week (DDW) 2024 Annual Meeting. Washington, DC. May 18-21, 2024.