Early Intestinal Ultrasound Changes Predict Transmural Healing in Crohn’s Disease
Early Intestinal Ultrasound Predicts Long-Term Response in Crohn’s Disease
- Per Inflammatory Bowel Diseases (2026): Prospective multicenter cohort of 142 patients with Crohn’s disease initiating biologic therapy; intestinal ultrasound (IUS) assessed baseline, 3 months, and 12 months to evaluate whether early bowel wall thickness (BWT) and Limberg score changes predicted 12-month transmural healing (TH).
- Key outcomes: TH occurred in 19% and overall IUS response in 44%. A ≥1.25-mm BWT reduction at 3 months predicted TH (73% sensitivity, 61% specificity; P=.0004) and IUS response (83% sensitivity, 57% specificity; P<.0001).
- Clinical relevance: Combining ΔBWT with Limberg score improvement showed the strongest association with TH (OR, 13.26; P<.0001) and IUS response (OR, 20.9; P<.0001), supporting early IUS assessment as a predictor of 12-month treatment response.
Early improvement in intestinal ultrasound (IUS) parameters during biologic therapy may help identify patients likely to achieve transmural healing (TH) at 12 months, according to results from a prospective multicenter study of patients with Crohn’s disease (CD).
Investigators enrolled 142 patients with CD initiating biologic therapy and performed serial IUS assessments at baseline, 3 months, and 12 months. The study evaluated changes in bowel wall thickness (BWT) and Doppler-derived Limberg scores during the first 3 months of treatment and assessed their ability to predict later outcomes.
At 12 months, the transmural healing rate was 19%, while the overall IUS response rate was 44%.
Patients who achieved TH demonstrated significantly greater reductions in bowel wall thickness during the first 3 months of therapy than patients who did not achieve TH (P = .0004). Receiver operating characteristic analysis identified a reduction in BWT of 1.25 mm as the optimal threshold for predicting TH, with 73% sensitivity and 61% specificity.
The same threshold also predicted overall IUS response, yielding 83% sensitivity and 57% specificity. Investigators reported that IUS responders experienced significantly greater reductions in BWT than nonresponders (P < .0001).
The strongest predictive signal emerged when bowel wall thickness changes were combined with Doppler findings. According to the authors, “the combination of ΔBWT and Limberg score improvement was strongly associated with both TH” and IUS response at 12 months. This combined measure was associated with TH (OR, 13.26; P < .0001) and IUS response (OR, 20.9; P < .0001).
The investigators concluded that “early reduction in BWT, especially when combined with Limberg score, is a strong predictor of TH and IUS response at 12 months.”
Reference
De Cristofaro E, Zorzi F, Colella A, et al. Early intestinal ultrasound assessment predicts therapy response: An easy tool for clinical decision-making. Inflamm Bowel Dis. 2026;32(5):938-944. doi:10.1093/ibd/izaf317
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