Ultrasound scans may help physicians predict which patients with severe ulcerative colitis won't respond to steroid treatment, according to a January 5 study published in Ultrasound in Medicine & Biology. As a result, these patients could gain quicker access to alternative colon-saving therapies.
Physicians typically administer corticosteroids to patients admitted to the hospital with severe ulcerative colitis, but about one-third of these patients don't respond to the treatment. The small pilot study showed that bowel thickness measurements on ultrasound scans may indicate which patients are more likely to need salvage therapy.
"The key finding was that the simple measurement of bowel wall thickness of affected colonic segments at admission provided a clear guide to subsequent failure of steroids," wrote the authors, led by Dr. Rebecca Smith, a gastroenterologist at Alfred Hospital in Melbourne, Australia.
Smith and colleagues conducted their study with 10 patients who were hospitalized for an ulcerative colitis flare that required treatment with intravenous corticosteroids four times per day. The patients ranged in age from 21 to 39, and 90% were male.
Two independent gastroenterologists conducted gastrointestinal ultrasound scans on the patients at three different time points:
- Within 24 hours of admittance and starting steroids
- On the third day of steroid treatment
- On the seventh day after admittance if the patient was still in the hospital
The gastroenterologists used ultrasound scans to calculate bowel wall thickness measurements for the patients at each of the three time points as well as two weeks and three months after hospital discharge.
| Difference in bowel wall thickness (BWT) after corticosteroid treatment | |||
| Responded to steroids | Did not respond to steroids | ||
| Admission | Median BWT for all colonic segments | 4.6 mm | 6.2 mm |
| Median BWT for most affected colonic segment | 4.7 mm | 7.4 mm | |
| Day 3 | Median BWT for all colonic segments | 4 mm | 6.3 mm |
A total of six patients required salvage therapy with infliximab -- five who started therapy on day three and one who commenced therapy on day seven. Ultimately, three patients required a colectomy within 30 days of admission.
The four patients who responded to the steroid treatment had lower initial colonic bowel wall thickness measurements on ultrasound than the patients who required salvage therapy. Within 24 hours of admission, every patient who had a bowel wall thickness measurement of 6 mm or higher in any colonic segment required salvage therapy -- a finding that was statistically significant.
Importantly, the ultrasound-derived measurements proved significant, while endoscopic scores and appearances showed no value in discriminating patients who did and did not respond to steroids.
The two groups had even greater differences in bowel wall thickness measurements later in their hospital stay. On the third day of steroid treatment, patients who responded to treatment had statistically improved bowel wall thickness measurements, whereas the patients who required salvage therapy had no change.
Although the study was small, the findings exemplified the promise of ultrasound-derived measurements for treatment planning for patients with severe ulcerative colitis. The authors also pointed out that gastrointestinal ultrasound has its own benefits outside of the scope of the study, such as stratifying patients by risk level and potentially preventing the need for a colonoscopy.
"This pilot study has indicated the potential utility of gastrointestinal ultrasound in patients admitted to hospital with severe colitis by providing early and accurate prognostic information regarding the likelihood of response to corticosteroids," they concluded. "Combining this with its noninvasive nature and the information it provides on disease distribution, gastrointestinal ultrasound may be an important tool in optimizing and personalizing management of patients with severe ulcerative colitis."
