Intestinal Ultrasound in Clinical Inflammatory Bowel Disease Care: From Diagnosis to Tight Monitoring

Intestinal ultrasound (IUS) has emerged as an essential imaging modality in inflammatory bowel disease (IBD), offering real-time, radiation-free assessment at the point of care. This review summarizes current evidence on practical techniques, diagnostic performance, and the expanding role of IUS in treat-to-target strategies. Standardized protocols incorporate bowel wall thickness, color Doppler signal, bowel wall stratification, and mesenteric fat assessment as core parameters. Meta-analyses demonstrate high sensitivity and specificity for detecting active inflammation in Crohn’s disease and ulcerative colitis, with IUS parameters correlating strongly with endoscopic disease activity scores. Validated scoring systems, including the International Bowel Ultrasound Segmental Activity Score, enhance standardization in clinical practice and trials. Beyond baseline assessment, IUS enables early therapeutic response monitoring, with bowel wall thickness reduction and Doppler normalization predicting favorable long-term outcomes including reduced hospitalization and surgery rates. IUS remission is associated with lower relapse risk compared with clinical response alone. Additionally, IUS provides unique advantages in specific clinical situations. As understanding of transmural inflammation deepens and training programs expand globally, IUS is positioned as a central tool for achieving deep, durable remission and optimizing long-term outcomes in IBD management.