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Early Intestinal Ultrasound Accurately Predicts Long-Term Endoscopic Response to Biologic Therapy in Ulcerative Colitis

Marietta Iacucci, MD, PhD, FASGE reviewing Allocca M, et al. J Crohns Colitis 2023 Apr 21.

A treat-to-target strategy with close monitoring of treatment response is recommended in ulcerative colitis (UC). Colonoscopy is the gold standard for assessing disease activity. However, intestinal ultrasound (IUS) is a noninvasive, safe, and accurate technique routinely used in clinical practice to detect changes related to treatment response. Milan ultrasound criteria (MUC) is a validated ultrasonographic score able to grade endoscopic activity in UC, with a score ≤6.2 predictive of a Mayo endoscopic score (MES) ≤1. However, few studies have compared the responsiveness of IUS and colonoscopy. 

In this single-center, prospective, observational study, 49 patients starting biologic therapy for active UC (MES >1) underwent both colonoscopy and IUS at baseline and reassessment within one year, with a further IUS examination at week 12. The investigators evaluated the predictive value of ultrasound improvement (MUC ≤6.2) at week 12 for treatment response and endoscopic improvement (MES ≤1) at reassessment. 

MUC values significantly decreased after 12 weeks of treatment and at reassessment, with a high positive correlation between MES and MUC scores. MUC ≤6.2 at week 12 was the only independent predictor of endoscopic improvement (odds ratio [OR], 5.80; P=.010) and remission (OR, 10.41; P=.041) at reassessment, with a negative predictive value of 96% for detecting endoscopic remission. A reduction of ≥2 points in the MUC score predicted achievement of endoscopic improvement (area under the receiver operating characteristics [AUROC], 0.806) and remission (AUROC, 0.816), with MUC ≤4.3 as the most accurate cut-off value for an MES of 0.


IUS is a noninvasive, cost-saving tool for UC monitoring. In this study, IUS using the MUC accurately assessed response to treatment after 12 weeks and predicted endoscopic improvement at one year. This technique can help with early tight control to monitor response to treatment and guide therapeutic management when endoscopy is not feasible. However, multicenter studies are needed to confirm these data.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Marietta Iacucci, MD, PhD, FASGE

Bio and Disclosures


Allocca M, Dell’Avalle C, Furfaro F, et al. Early intestinal ultrasound predicts long-term endoscopic response to biologics in ulcerative colitis. J Crohns Colitis 2023 Apr 21. (Epub ahead of print) (