Colonoscopy versus bowel ultrasound in assessment of disease activity and severity in patients with Ulcerative Colitis

Abstract

Ulcerative colitis [UC] is a chronic inflammatory bowel disease characterized by relapsing and remitting episodes of inflammation usually limited to the mucosal layer of the colon. Treatment targets for UC patients nowadays include patient-reported as well as endoscopic remission. Recently, endoscopy is increasingly being used to guide treatment, because evidence suggests that mucosal healing is associated with improved long-term outcomes. However, it is challenging to repeatedly perform colonoscopies to assess mucosal disease activity due to the high cost and burden for the patient. Hence, alternative and reliable non-invasive methods to assess disease activity are needed. Ulcerative colitis [UC] is a chronic idiopathic inflammatory disorder that causes mucosal inflammation of the colon and is characterized by a relapsing-remitting clinical course. Activity and severity of inflammation influence management and treatment modality of Ulcerative colitis patients. Colonoscopy [CS] is considered the first-lineprocedure for the assessment of Ulcerative colitis. Blood tests such as the measurement of serum C-reactive protein [CRP], albumin and platelet counts have been evaluated, but these tests are not sufficiently sensitive or specific to reflect disease activity.Repeated measurement of faecal calprotectin [FCP] has been shown to accurately reflect the presence of disease activity. However, disease location, extent and severity cannot be adequately assessed with this technique. Intestinal ultrasound [IUS] is a rapid, efficient, non-invasive and relatively cheap imaging technique, which can also be performed in point-of-care settings. IUS has been reported to be accurate in the diagnosis of Ulcerative colitis and can also be applied to determine the extent, severity and location of inflammation. Managing ulcerative colitis necessitate objective methods not only during control of active disease but also during follow up for better detection of disease activity and determining the site of involvement. Currently colonoscopy is the standard method for evaluating ulcerative colitis activity, severity and expansion but this procedure is invasive and during sever disease flare could be non-applicable due to fear of complications such as bleeding and perforation. Moreover many patients are reluctant to endoscopic procedures during each flare. So, availability of an accurate noninvasive method for determining disease activity and extension is mandatory.