P0550IBUS Topical review on Special Situations: The role of intestinal ultrasound in pregnant IBD patients

Abstract Background Active inflammatory bowel disease (IBD) is linked to poor foetal and maternal outcomes, highlighting the importance of optimal disease control during pregnancy1. Intestinal ultrasound (IUS) has emerged as an accurate tool for monitoring IBD2. In this systematic review and consensus statement, we aimed to provide guidance for clinical practice based on current evidence and expert experience. Methods A systematic review was conducted to generate statements and graded for evidence (www.cebm.ox.ac.uk). Multiple databases (EMBASE, PubMed, Cochrane) were searched and studies were included by consensus of two reviewers. Inclusion criteria included all studies in which pregnant IBD patients underwent IUS and either i) compared IUS findings to biochemical markers and/or other imaging modalities or ii) feasibility of IUS was evaluated or iii) IUS in monitoring treatment response was assessed or iv) predictive value of IUS findings on maternal and foetal outcomes was investigated. Subsequently, a Delphi consensus with a two-round voting process was established and consensus was reached when agreement (strongly agree or agree) reached 80%. Results In total, of 873 abstracts screened, eight studies were included (n = 4 cohort studies; n = 4 case reports). Up to early second trimester adequate views for all bowel segments were feasible in 90% of 180 pooled ultrasound examinations, whereas in third trimester feasibility was decreased in the sigmoid colon and terminal ileum. A bowel wall thickness (BWT) 3.0 mm, combined with a faecal calprotectin 100 ug/g, was most accurate to distinguish active from quiescent disease across the four cohort studies. No studies compared IUS to other imaging modalities or endoscopy in pregnancy. BWT6.0 mm and presence of other IUS findings were more frequently used to grade disease severity. In addition, IUS demonstrated accuracy in monitoring disease activity and treatment response throughout pregnancy but sample sizes were small. One study including 234 patients demonstrated worse foetal and maternal outcomes when BWT exceeded 6.0 mm3. There was moderate evidence for feasibility and diagnostic accuracy statements and low evidence for monitoring and foetal/maternal outcomes statements (Table 1). A total of 41 participants voted on all statements and all reached 80% agreement. Highest agreement was reached on feasibility and accuracy for IUS in pregnancy. Conclusion In summary, intestinal ultrasound demonstrates feasibility and accuracy for evaluating disease activity in pregnant patients with inflammatory bowel disease. Although current evidence is limited, IUS may be incorporated into monitoring strategies to guide treatment optimization and improve maternal and foetal outcomes. References: 1. Mahadevan U, Seow CH, Barnes EL, et al. Global consensus statement on the management of pregnancy in inflammatory bowel disease. Journal of Crohn’s and Colitis. 2025;19(8):jjaf129. 2. Kucharzik T, Taylor S, Allocca M, et al. ECCO-ESGAR-ESP-IBUS guideline on diagnostics and monitoring of patients with inflammatory bowel disease: Part 1: Initial diagnosis, monitoring of known inflammatory bowel disease, detection of complications. Journal of Crohn’s and Colitis. 2025;19(7):jjaf106. 3. Prentice RE, Flanagan EK, Wright EK, et al. Active Inflammatory Bowel Disease on Intestinal Ultrasound During Pregnancy Is Associated With an Increased Risk of Adverse Pregnancy and Neonatal Outcomes Independent of Clinical and Biochemical Disease Activity. Gastroenterology. 2025; doi:10.1053/j.gastro.2025.03.016 Conflict of interest: Fraquelli, Mirella: Personal Fees: Speaker and/or honoraria fees from AbbVie, Galapagos, Janssen, Pfizer and Takeda Verstockt, Bram: Research support from AbbVie, Biora Therapeutics, Celltrion, Landos, Pfizer, Sanofi, Sossei Heptares/Nxera and Takeda. Speaker’s fees from Abbvie, Agomab, Alfasigma, Biogen, Bristol Myers Squibb, Celltrion, Eli Lily, Falk, Ferring, Galapagos, Materia Prima, Johnson and Johnson, Pfizer, Sandoz, Takeda, Tillots Pharma, Truvion and Viatris. Consultancy fees from Abbvie, Alfasigma, Alimentiv, Anaptys Bio, Applied Strategic, Astrazeneca, Atheneum, BenevolentAI, Biora Therapeutics, Boxer Capital, Bristol Myers Squibb, Domain Therapeutics, Eli Lily, Galapagos, Guidepont, Landos, Merck, Mirador Therapeutics, Mylan, Nxera, Inotrem, Ipsos, Johnson and Johnson, Pfizer, Sandoz, Sanofi, Santa Ana Bio, Sapphire Therapeutics, Sosei Heptares, Takeda, Tillots Pharma and Viatris. Stock options Vagustim and Thethis Pharma. Allocca, Mariangela: Personal Fees: consulting fees from Nikkiso Europe, Mundipharma, Janssen, Abbvie, Pfizer, Ferring, Galapagos, Sandoz, Lilly and Alfasigma Meade, Susanna: Speaker fees FalkPharma, Abbvie Conference fees J and J Ad board J and J Dragoni, Gabriele: Personal Fees: Speaker and/or honoraria fees from AbbVie, Galapagos, Janssen, Pfizer and Takeda Kellar, Amelia: No conflicts Flanagan, Emma: Grant: Research grant from Ferring. Personal Fees: Personal fees from Abbvie, Ferring, Janssen, Sandoz, Takeda. Educational support from Pfizer. Dolinger, Michael: Personal Fees: Michael Dolinger is a consultant for Neruologica., a subsidiary of Samsung Electronics Co., Ltd. Sagami, Shintaro: Shintaro Sagami has served as an advisory board member, consultant, or speaker for AbbVie, Alimentiv, Bristol Myers Squibb, Celltrion, EA Pharma, Eli Lilly, Ferring Pharmaceuticals, Gilead Sciences, Janssen Pharmaceuticals, Kyorin Pharmaceutical, Mitsubishi Tanabe Pharma, Mochida Pharmaceutical, Nippon Kayaku, Pfizer, Takeda, and Zeria Pharmaceutical, and has received research funding from Bristol Myers Squibb, EA Pharma, Gilead Sciences, Helmsley Charitable Trust, JIMRO, Kyorin Pharmaceutical, Miyarisan, Mochida Pharmaceutical, Nippon Kayaku, Pfizer, Sekisui Medical, Samsung, Takeda, and Zeria Pharmaceutical. Lu, Cathy: Advisory board - Abbvie, JnJ, Takeda, Ferring, Merck, Celltrion, Pfizer Research Funding - Abbvie, JnJ Winter, Michael: No conflict of interest Seidelin, Jakob Benedict: No conflict of interest Blunt, Heather: No conflict of interest Vitale, Elaina: No conflict of interest Dr. de Voogd, Floris: Report speaker and/or honoraria fees from AbbVie, Pfizer and Takeda