Ultrasonography in the evaluation of extension, activity, and follow-up of ulcerative colitis

Background: The purpose of the study was to establish the clinical significance of bowel-wall thickening, measured by ultrasound, in ulcerative colitis (UC) and to evaluate the usefulness of ultrasonography (US) to define the extension, the severity, and the response to medical treatment of this pathologic condition. Methods: Thirty consecutive patients with active UC were studied on two different occasions 2 months apart and after treatment with steroids. On both occasions the clinical, endoscopic, and biochemical activity of the disease and the ultrasonographic examination of the intestinal walls were evaluated. The maximum bowel wall thickness (BWT) was considered an index of ultrasonographic activity, and the presence of thickened bowel walls and the US appearance of loss of haustra coli were considered in the evaluation of the extension of disease. The extension of colitis was evaluated by means of a double-contrast barium enema in every patient at the beginning of the study. Results: US correctly defined the extension of UC in 74% of the patients as defined by double-contrast barium enema. The degree of BWT was significantly correlated to the clinical, biochemical, and endoscopic activity of UC before and after the treatment. Moreover, BWT decreased significantly (7.3 +/- 1.9 mm versus 5.1 +/- 1.2 mm; P < 0.001) in patients who experienced clinical improvement after treatment, and it did not change (7.0 +/- 1.5 mm versus 7.0 +/- 1.4 mm, P=NS) in patients showing no significant clinical improvement. The degree of pretreatment BWT did not differ between UC patient responders and non-responders. Conclusions: US evaluation of BWT may be useful in evaluating the extension of UC. The degree of BWT, as evaluated by US, correlates with the clinical, biochemical, and endoscopic activity of UC, both before and after treatment. This suggests that US may be useful to evaluate the response of UC patients to medical therapy.