Utility of abdominal ultrasonography in the diagnosis and monitoring of inflammatory bowel disease

Abdominal ultrasonography has been undervalued for years as technique used in examining the gastrointestinal tract. However, thanks to the technological advances that have been seen in ultrasonography probes and the use of high frequency equipment, we are able to obtain high quality images of the intestinal wall. Moreover, due to the increased sensitivity of the colour Doppler, we can detect the parietal vascularization. Finally, in recent years, intravenous ultrasonography contrast agents have been used that allow not only the inflammatory activity to be quantified but also the presence of complications with a diagnostic accuracy similar to computed tomography (CT) and full magnetic resonance (full-RM), without the associated radiation risk and at a lower cost. This article reviews the utility of abdominal ultrasonography in inflammatory bowel disease, in particular Crohn's disease, both during initial diagnosis and follow-up of the disease; the article also reviews the ability of the technique to be used in the detection of complications (stenosis, fistulas and abscesses)

Early treatment with anti-tumor necrosis factor agents improves long-term effectiveness in symptomatic stricturing Crohn's disease.

There is limited evidence on the effectiveness of biological therapy in stricturing complications in patients with Crohn's disease. The study aims to determine the effectiveness of anti-tumor necrosis factor (TNF) agents in Crohn's disease complicated with symptomatic strictures. In this multicentric and retrospective study, we included adult patients with symptomatic stricturing Crohn's disease receiving their first anti-TNF therapy, with no previous history of biological, endoscopic or surgical therapy. The effectiveness of the anti-TNF agent was defined as a composite outcome combining steroid-free drug persistence with no use of new biologics or immunomodulators, hospital admission, surgery or endoscopic therapy during follow-up. Overall, 262 patients with Crohn's disease were included (53% male; median disease duration, 35 months, 15% active smokers), who received either infliximab (N = 141, 54%) or adalimumab (N = 121, 46%). The treatment was effective in 87% and 73% of patients after 6 and 12 months, respectively, and continued to be effective in 26% after a median follow-up of 40 months (IQR, 19-85). Nonetheless, 15% and 21% of individuals required surgery after 1 and 2 years, respectively, with an overall surgery rate of 32%. Postoperative complications were identified in 15% of patients, with surgical site infection as the most common. Starting anti-TNF therapy in the first 18 months after the diagnosis of Crohn's disease or the identification of stricturing complications was associated with a higher effectiveness (HR 1.62, 95% CI 1.18-2.22; and HR 1.55, 95% CI 1.1-2.23; respectively). Younger age, lower albumin levels, strictures located in the descending colon, concomitant aminosalicylates use or presence of lymphadenopathy were associated with lower effectiveness. Anti-TNF agents are effective in approximately a quarter of patients with Crohn's disease and symptomatic intestinal strictures, and 68% of patients are free of surgery after a median of 40 months of follow-up. Early treatment and some potential predictors of response were associated with treatment success in this setting