TY - JOUR
T1 - Intestinal Ultrasound Is Accurate to Determine Endoscopic Response and Remission in Patients With Moderate to Severe Ulcerative Colitis
T2 - A Longitudinal Prospective Cohort Study
AU - de Voogd, Floris
AU - van Wassenaer, Elsa A.
AU - Mookhoek, Aart
AU - Bots, Steven
AU - van Gennep, Sara
AU - Löwenberg, Mark
AU - D'Haens, Geert R.
AU - Gecse, Krisztina B.
N1 - Funding Information: Order of Authors (with Contributor Roles):, Floris de Voogd, MD (Conceptualization: Equal; Data curation: Lead; Formal analysis: Lead; Investigation: Equal; Methodology: Equal; Project administration: Lead; Writing – original draft: Lead). Elsa A. van Wassenaer, MD (Data curation: Equal; Investigation: Equal; Writing – review & editing: Equal). Aart Mookhoek, MD, PhD (Data curation: Equal; Investigation: Equal; Writing – review & editing: Equal). Steven Bots, MD (Conceptualization: Equal; Writing – review & editing: Equal). Sara van Gennep, MD (Conceptualization: Equal; Data curation: Equal; Investigation: Equal; Writing – review & editing: Equal). Mark Löwenberg, MD, PhD (Conceptualization: Equal; Data curation: Equal; Investigation: Equal; Supervision: Equal; Writing – review & editing: Supporting). Geert R. D'Haens, MD, PhD (Conceptualization: Lead; Data curation: Equal; Investigation: Lead; Methodology: Supporting; Project administration: Equal; Supervision: Lead; Writing – review & editing: Lead). Krisztina Gecse, MD, PhD (Conceptualization: Lead; Data curation: Equal; Investigation: Equal; Supervision: Lead; Writing – review & editing: Lead). Publisher Copyright: © 2022 AGA Institute
PY - 2022/12/1
Y1 - 2022/12/1
N2 - Background & Aims: Intestinal ultrasound (IUS) is noninvasive, cost-effective, and accurate to determine disease activity in ulcerative colitis (UC). In this study, we prospectively evaluated IUS for treatment response in a longitudinal cohort by using endoscopy and histology as gold standards. Methods: Consecutive patients with moderate to severe UC (endoscopic Mayo score [EMS] ≥2) starting tofacitinib treatment were included. Patients were evaluated at baseline and after 8 weeks of tofacitinib induction by means of clinical, biochemical, endoscopic (EMS and UC endoscopic index for severity), histologic (Robarts Histopathologic Index) and IUS assessments. Readers of IUS, endoscopy, and histology were blinded for all other outcomes. The primary outcome was difference in bowel wall thickness (BWT) for endoscopic improvement vs no endoscopic improvement. Endoscopic remission was defined as EMS = 0, improvement as EMS ≤1, and response as a decrease of EMS ≥1. Results: Thirty patients were included, with 27 patients completing follow-up. BWT correlated with EMS (ρ = 0.68, P <.0001), UC endoscopic index for severity (ρ = 0.73, P <.0001) and Robarts Histopathologic Index (ρ = 0.49, P =.002) at both time points. BWT in the sigmoid was lower in patients with endoscopic remission (1.4 mm vs 4.0 mm, P =.016), endoscopic improvement (1.8 mm vs 4.5 mm, P <.0001) and decrease in BWT was more pronounced in patients with endoscopic response (−58.1% vs −13.4%, P =.018). The most accurate cutoff values for BWT were 2.8 mm (area under the curve [AUC] 0.87) for endoscopic remission, 3.9 mm (AUC 0.92) for improvement, and decrease of 32% (AUC 0.87) for response. The submucosa was the most responsive wall layer. Conclusion: IUS, importantly BWT as the single most important parameter, is highly accurate to detect treatment response when evaluated against endoscopic outcomes.
AB - Background & Aims: Intestinal ultrasound (IUS) is noninvasive, cost-effective, and accurate to determine disease activity in ulcerative colitis (UC). In this study, we prospectively evaluated IUS for treatment response in a longitudinal cohort by using endoscopy and histology as gold standards. Methods: Consecutive patients with moderate to severe UC (endoscopic Mayo score [EMS] ≥2) starting tofacitinib treatment were included. Patients were evaluated at baseline and after 8 weeks of tofacitinib induction by means of clinical, biochemical, endoscopic (EMS and UC endoscopic index for severity), histologic (Robarts Histopathologic Index) and IUS assessments. Readers of IUS, endoscopy, and histology were blinded for all other outcomes. The primary outcome was difference in bowel wall thickness (BWT) for endoscopic improvement vs no endoscopic improvement. Endoscopic remission was defined as EMS = 0, improvement as EMS ≤1, and response as a decrease of EMS ≥1. Results: Thirty patients were included, with 27 patients completing follow-up. BWT correlated with EMS (ρ = 0.68, P <.0001), UC endoscopic index for severity (ρ = 0.73, P <.0001) and Robarts Histopathologic Index (ρ = 0.49, P =.002) at both time points. BWT in the sigmoid was lower in patients with endoscopic remission (1.4 mm vs 4.0 mm, P =.016), endoscopic improvement (1.8 mm vs 4.5 mm, P <.0001) and decrease in BWT was more pronounced in patients with endoscopic response (−58.1% vs −13.4%, P =.018). The most accurate cutoff values for BWT were 2.8 mm (area under the curve [AUC] 0.87) for endoscopic remission, 3.9 mm (AUC 0.92) for improvement, and decrease of 32% (AUC 0.87) for response. The submucosa was the most responsive wall layer. Conclusion: IUS, importantly BWT as the single most important parameter, is highly accurate to detect treatment response when evaluated against endoscopic outcomes.
KW - Intestinal Ultrasound
KW - Monitoring
KW - Tofacitinib
KW - Treatment Response
KW - Ulcerative Colitis
UR - http://www.scopus.com/inward/record.url?scp=85140325498&partnerID=8YFLogxK
U2 - https://doi.org/10.1053/j.gastro.2022.08.038
DO - https://doi.org/10.1053/j.gastro.2022.08.038
M3 - Article
C2 - 36030056
SN - 0016-5085
VL - 163
SP - 1569
EP - 1581
JO - Gastroenterology
JF - Gastroenterology
IS - 6
ER -