Non-invasive monitoring & treatment strategies in paediatric inflammatory bowel disease

Inflammatory Bowel Disease (IBD) is a debilitating chronic condition, with a relapsing and remitting disease course. Intensive monitoring of disease activity - preferably non-invasively - is increasingly recognised and propagated, as subclinical inflammation can lead to disease progression and complications. However, frequent hospital visits for consultation, diagnostic procedures, and in-hospital treatments, have a great impact on patients and caretakers lives.
Therefore, this thesis focused on non-invasive monitoring strategies, with a focus on the use of intestinal ultrasound (IUS). We first summarised potential uses and misuses of point-of-care ultrasound (POCUS), set a basis for normal values for IUS measurements and uncovered gaps in scientific evidence for the use of IUS in paediatric IBD. We then analysed the patient perspectives on different monitoring modalities and we aimed to fill the gaps in knowledge with regard to standardised scoring systems for IUS and diagnostic accuracy of IUS. Furthermore, we assessed whether a healthcare professional can be trained to perform a point-of-care IUS with equal accuracy as a paediatric radiologist and lastly, we demonstrated the clinical added value of IUS as point-of-care monitoring tool. In addition, we assessed whether two different assays for measuring faecal calprotectin (FC) can be used interchangeably in IBD treatment, as patients frequently switch between different hospitals, where different assays are used.
In addition, we assessed the safety of two different strategies to reduce in-hospital time with regard to infliximab (IFX) infusions; first by eliminating the need for pre-medication and second by reducing the infusion time.