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The following is a summary of “Intestinal Ultrasound Findings and Their Prognostic Value in Early Crohn’s Disease – a Copenhagen IBD Cohort Study,” published in the March 2025 issue of the Clinical Gastroenterology and Hepatology by Madsen et al.

Intestinal ultrasound (IUS) has emerged as a noninvasive imaging modality for assessing inflammation and monitoring disease progression in patients with newly diagnosed Crohn’s disease. However, the prognostic significance of IUS findings in early-stage Crohn’s disease remains unclear. This prospective, population-based cohort study aimed to evaluate the prognostic value of IUS in assessing disease activity and predicting clinical outcomes during the first year following diagnosis. Patients newly diagnosed with adult-onset Crohn’s disease were followed prospectively with IUS, alongside symptomatic, biochemical, and endoscopic evaluations. A total of 390 adult patients were included in the study, all undergoing baseline and follow-up IUS assessments. At diagnosis, no significant correlation was observed between the presence of sonographic inflammation and the duration of diagnostic delay. 

At the three-month follow-up, 38% of patients achieved transmural remission, defined as the resolution of sonographic signs of active inflammation. Patients with colonic involvement exhibited a higher likelihood of presenting with transmural remission at this early stage. The presence of transmural remission at three months was significantly associated with sustained steroid-free clinical remission at three months and across all subsequent follow-ups within the first year. Additionally, patients who achieved transmural remission had a substantially lower risk of requiring treatment escalation within 12 months (26% vs. 53%, p=0.01). By the 12-month follow-up, transmural remission was achieved in 41% of patients. Importantly, the study identified that a higher baseline BMI was negatively associated with the likelihood of achieving and maintaining 12-month transmural remission, with overweight ([OR] = 0.34; 95% [CI]: 0.12–0.94) and obesity (OR 0.16, 95% CI: 0.16–0.94) significantly reducing the probability of long-term transmural healing. 

The International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) in the terminal ileum at diagnosis emerged as the most accurate predictor of ileocecal resection within the first year of disease progression, with an optimal threshold value of 63 [AUC]: 0.92; sensitivity: 0.92). The findings suggest that IUS can serve as an effective tool in early-stage Crohn’s disease for monitoring transmural healing, predicting the need for treatment escalation, and forecasting surgical intervention requirements. 

Importantly, achieving transmural remission within the first three months was correlated with favorable long-term clinical outcomes, including sustained steroid-free remission and a reduced need for treatment escalation during the first year. This study highlights the potential of IUS as a valuable, noninvasive modality in the routine assessment of patients with newly diagnosed Crohn’s disease and underscores the prognostic implications of early ultrasound findings. Future research should focus on refining IUS-based scoring systems and validating their utility in guiding individualized treatment strategies for Crohn’s disease management.

Source: cghjournal.org/article/S1542-3565(25)00158-2/abstract