AdventHealth Inflammatory Bowel Disease Clinic Adds Intestinal Ultrasound to Help Evaluate and Guide Treatment

Certified by the International Bowel Ultrasound Group, AdventHealth IBD Clinic Medical Director Jennifer Seminerio, MD, recently became one of the first in Florida to use intestinal ultrasound (IUS) to help assess and manage treatment of patients with inflammatory bowel disease (IBD). A non-invasive, radiation-free imaging technique, IUS provides high-resolution transabdominal examination of the colon and small intestine without bowel preparation, fasting or contrast. It has emerged as a new tool for objectively assessing and monitoring IBD activity.

“IUS significantly enhances the care we can provide our IBD patients,” shares Dr. Seminerio. “It allows us to not only evaluate the thickness and inflammation of the colon and small bowel but also look at movement within them. This new tool won’t replace our other diagnostic modalities, but it provides us real-time, in-office imaging to see if the disease we’re treating is active and if the current treatment is working. That allows us to make point-of-care adjustments in partnership with our patients to help prevent disease progression.”

Challenges with Monitoring IBD

A chronic disorder encompassing both Crohn’s disease and ulcerative colitis, IBD is characterized by inflammation that can lead to bowel obstructions, fistulas and cancer. Treatment aims to reduce inflammation to help promote clinical remission and prevent these disease complications.

The conventional approach to monitoring IBD in the U.S. has centered on routine gastroenterology visits as well as periodic blood tests to check C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels, stool tests to measure fecal calprotectin levels, computed tomography (CT) enterography, magnetic resonance enterography (MRE) and colonoscopy. Patients can face delays and challenges in completing these procedures, and compliance rates can be low.

Using Intestinal Ultrasound to Help Manage IBD

While relatively new to the U.S., specialists in Europe and Canada have used IUS to help manage IBD for more than a decade. Performed in clinic by a specially trained and certified gastroenterologist, the scan includes global assessment of the bowel using a low-frequency convex transducer as well as evaluation of disease activity using a higher-frequency linear transducer. Key measurements obtained include bowel wall thickness and bowel wall hyperemia (excess blood). Using IUS, the physician can see the degree of inflammation in the bowel as well as the presence of complications such as abscesses, strictures or fistulas.

“IUS helps us to more quickly and non-invasively evaluate the extent and severity of a patient’s disease so we can determine how well the bowel is responding to treatment and make timely medication adjustments if needed,” explains Dr. Seminerio.

Several studies have shown IUS to be accurate in detecting inflammation in both the small intestine and colon. In one multicenter study of IUS to evaluate treatment response in patients with Crohn’s disease, improvements could be identified within 3 months of initiating biologic therapy, including reduction in bowel wall thickening or stratification. In a separate multicenter study of IUS in patients with active ulcerative colitis, normalization of the bowel wall thickness was visualized as early as 2 weeks after treatment change.

IUS can also help identify flares and improve monitoring of disease activity for several special populations where traditional diagnostics are contraindicated due to the need for radiation, sedation or contrast. This includes patients who are pregnant, patients with pacemakers, or those with comorbidities like renal failure.

“Incorporating the use of intestinal ultrasound into our IBD clinic enhances our patient-centered approach to care,” says Dr. Seminerio. “It is a safe, convenient, cost-effective way to strengthen shared decision-making, helping us and our patients feel more confident in managing their disease.”