Bowel ultrasound an effective tool for assessing patients with chronic inflammatory bowel disease

Tillmann Raith, Mladen Makitan and Peter Gedeon, gastroenterologists at Skåne University Hospital.

Approximately 100,000 people in Sweden live with chronic inflammatory bowel disease (IBD). To examine the bowel, healthcare providers often rely on imaging methods such as CT scans or colonoscopy – but a simple, non-invasive ultrasound can be just as effective. Now, a team of doctors at Skåne University Hospital is working to promote this method at more clinics across Sweden.

Getting a diagnosis can be a lengthy process for someone with IBD, such as ulcerative colitis or Crohn’s disease. Delays can occur for several reasons. One is that symptoms – abdominal pain, diarrhoea, bloody stools, and fatigue – are not specific to IBD and can be seen in other gastrointestinal conditions. Another is that standard diagnostic tools like MRI or CT often involve long waiting times.

“Colonoscopy, MRI, and CT are all excellent diagnostic methods. However, colonoscopy can be uncomfortable, which may discourage some patients from seeking care,” says Tillmann Raith, consultant in gastroenterology at Skåne University Hospital.

Together with colleagues Peter Gedeon, senior consultant, and Mladen Makitan, consultant, he is advocating for the wider use of an alternative method: bowel ultrasound. This technique uses ultrasound to detect signs of active inflammation or other IBD-related abnormalities in the intestines.

“We can examine patients directly in the clinic, using relatively simple equipment that doesn’t require extensive resources or much time. It’s a risk-free method that patients often appreciate as it’s quick and painless,” says Tillmann Raith.

Monitoring patients with IBD

At Skåne University Hospital, where the gastroenterology outpatient clinic in Malmö cares for around 5,000 patients with IBD, bowel ultrasound is routinely used to monitor disease activity.

“It’s an examination that can be repeated as often as needed. We’re available at short notice in the clinic and can assess patients quickly. The image quality with ultrasound has improved enormously over the past 15 years, which significantly enhances the reliability of our findings,” says Peter Gedeon.

He emphasises that the method is not intended to replace traditional diagnostic tools.

“Very superficial changes cannot be detected by ultrasound – for those cases, patients need to be assessed with capsule endoscopy or colonoscopy. Changes in the pelvic region are more clearly seen using MRI. But bowel ultrasound is an effective complement that can help expedite treatment,” says Peter Gedeon.

Training colleagues

Skåne University Hospital is part of the European IBUS Group (International Bowel Ultrasound Group), which promotes the use of bowel ultrasound as a diagnostic tool. For the past year, the team in Skåne has been welcoming colleagues from across the Nordic region for two-week practical training sessions.

“Implementing bowel ultrasound requires time and resources from each clinic. But we’re seeing growing interest, and we hope more hospitals will recognise the benefits of the method. In the long term, we aim to share the training responsibility with other hospitals in Sweden,” says Tillmann Raith.

Research shows benefits

Mladen Makitan, researcher at Lund University, has conducted a study with his supervisor Associate Professor Jan Marsal comparing bowel ultrasound and MRI in assessing inflammation activity in IBD patients. The results suggest that, in many cases, bowel ultrasound provides diagnostic accuracy comparable to MRI.

The study was presented at the Swedish Gastro Days, a national conference for gastroenterologists, held from 14 to 16 May.

“Until recently, the scientific evidence supporting the method has been limited, which may partly explain why interest in it has been low. But in recent years, a growing body of research has clearly shown its benefits for patients,” says Mladen Makitan.