Abstract Background Identifying Crohn’s disease (CD) patients at elevated risk of relapse despite clinical remission is essential for optimizing long-term management. Intestinal ultrasound (IUS) offers a non-invasive, dynamic tool to detect subclinical inflammation and may help predict relapse. Methods This retrospective, single-center cohort study included patients with CD in clinical remission, defined by a Harvey-Bradshaw Index ≤4, who underwent standardized IUS between February and August 2021. Ultrasound assessments included bowel wall thickness (BWT), Limberg score, mesenteric fat hypertrophy, lymphadenopathy, and detection of strictures or complications. Patients were followed through March 2025 for clinical relapse, defined as symptomatic recurrence requiring treatment escalation. Multivariate logistic regression was performed to identify independent ultrasound predictors of relapse. Results A total of 422 patients (54% male, median age 49 years) were analyzed. During a median follow-up of approximately 36 months, 25.6% experienced clinical relapse. Relapse rates increased progressively with higher Limberg scores: 15% for Limberg 0, 20% for score 1, 33% for score 2, 46% for score 3, and 85.7% for score 4. In multivariate analysis, a Limberg score of 2 was associated with an adjusted odds ratio (aOR) of 3.3 (95% CI 1.4–7.6, p = 0.005), score 3 with an aOR of 5.7 (95% CI 2.1–15.6, p 0.001), and score 4 with an aOR of 15.1 (95% CI 2.6–88.2, p = 0.0014). Patients with any abnormal IUS findings had a significantly higher relapse rate (31.1% vs 16.0%, p = 0.00045) and shorter relapse-free survival (log-rank p = 0.0005). Conclusion These findings highlight the strong predictive value of IUS in stratifying relapse risk among CD patients in clinical remission. Incorporating IUS into routine monitoring may enable earlier identification of high-risk patients and support timely therapeutic interventions to prevent disease progression. Conflict of interest: Dr. Dussias, Nikolas: Consultant fee from Cadigroup and Janssen Melotti, Laura: No conflict of interest Mazzotta, Elena: No conflict of interest Propato, Rossella: No conflict of interest Gionchetti, Paolo: Personal Fees: Ferring, Celgene, Janssen, Takeda, Chiesi, Abbvie, Pfizer, MSD, Amgen, BMS, Gilead, Arena Eli-Lilly Alfa-Sigma Rizzello, Fernando: No conflict of interest
Dussias et al. (Thu,) studied this question.