Abstract Background Bowel ultrasonography (BUS) is increasingly utilized in the assessment and monitoring of inflammatory bowel disease (IBD), providing rapid non-invasive evaluation of bowel wall inflammation. In addition to established BUS characteristics such as bowel wall thickness (BWT) and structure (BWS), advanced modalities like shear-wave elastography (SWE) have broadened diagnostic insight by quantifying tissue stiffness in affected bowel loops and mesenteric fat. However, the prognostic value of BUS parameters, particularly elastography are inconclusive. Methods A prospective analysis was conducted on 56 IBD patients (32 Crohn’s disease, 24 ulcerative colitis) who underwent standardized BUS assessment, including BWT, BWS, Doppler signal (DS), and shear-wave elastography of the affected bowel and mesenteric fat. Clinical severity, inflammatory biomarkers,(C Reactive protein(CRP) and faecal calprotectin), endoscopic findings, and mesenteric features were collected.The cohort included 30 men (51.7%) and severe disease was present in 19 patients (32.8%), of whom 10 (52.6%) required treatment escalation.The primary endpoint was treatment escalation. Analyses included correlation testing, severity-group comparisons, and multivariable logistic regression incorporating clinical, biochemical, and BUS variables; model performance was assessed using ROC curves. Results DS correlated strongly with clinical severity (r = 0.66). SWE was associated with calprotectin (r = 0.65) and bowel wall thickness (r = 0.46), while bowel wall thickness demonstrated moderate correlation with CRP (r = 0.44). No significant associations were observed between SWE and CRP, BWS, mesenteric involvement, or disease duration. BUS features did not differ significantly between Crohn’s disease and ulcerative colitis. Univariate analysis showed DS was significantly associated with treatment escalation (p = 0.009), whereas SWE and wall thickness were not. A multivariable model incorporating clinical severity, CRP, SWE, vascularization, and BWS achieved good discriminative accuracy (AUC 0.79). Vascularization remained the strongest predictor (OR≈2.4; p≈0.07), while SWE lacked independent predictive value. Conclusion Among BUS-derived parameters, Doppler signal emerged as the strongest predictor of treatment escalation, showing clear association with inflammatory activity. SWE reflected biochemical and structural changes, but did not independently predict escalation. Although the small cohort may have limited the statistical power of some analyses, BUS appears central to guiding therapeutic decisions, with elastography serving as a complementary but non-prognostic tool. Conflict of interest: Dr. Les, Anda: No conflict of interest Saizu, Roxana Elena: No conflict of interest Bunduc, Stefania: No conflict of interest Gheorghe, Liana Simona: Pirvulescu, Iuliana: No conflict of interest Gheorghe, Cristian: No conflict of interest
Les et al. (Thu,) studied this question.