Ulcerative colitis (UC) has a relapsing-remitting course which necessitates frequent
follow-up examinations to monitor disease activity.
Disease management was previously guided by patient reported symptoms, and treatment
targets were based on symptom control. However, the patient's symptoms do not necessarily
correspond to inflammatory activity and current guidelines recommend that management
should be based on objective evaluations.
Ileocolonoscopy is considered the reference standard method for determining disease
status in Ulcerative colitis. Although validated and reproducible scoring systems are
complex and cumbersome to use in clinical practice, and even though ileocolonoscopy is an
excellent tool for activity monitoring, it cannot be performed on a regular basis as it
is invasive, is resourceintensive and causes considerable patient discomfort. As numerous
follow-up examinations are required, simple non-invasive surrogate markers are needed.
Biomarkers such as C-reactive protein [CRP] and faecal calprotectin are well established
in both primary work-up and disease monitoring.
Still, as they cannot depict disease location and have limited accuracy, additional tools
are required.
Gastrointestinal ultrasound [GIUS] has high diagnostic accuracy for detecting active CD,
and in trained hands, it can make significant impact on clinical decision-making.
Furthermore, as it is non-invasive, readily available and can be performed bedside, the
modality seems well suited for bedside and frequent activity monitoring.
Still, interpretation of the GIUS findings may be influenced by the sonographer's level
of experience. A standardized ultrasound activity index may simplify the interpretation
of the sonographic findings, allowing for easier comparison between different
examinations during follow-up. Although various sonographic activity scores are
available, the methodology for development was shown to be insufficient in most studies
and no index is in widespread clinical use.