Abstract Background Intestinal ultrasound (IUS) is a useful imaging modality for assessing inflammatory bowel disease (IBD) activity, representing convenience and patient preference. However, data on sonographic characteristics of elderly patients with ulcerative colitis (UC) are scarce, particularly considering anatomical and histological changes reported with aging. This study evaluates the diagnostic accuracy of IUS compared to endoscopy in a multicenter cohort of elderly UC patients. Methods UC patients aged ≥60 who underwent endoscopy and IUS within ≤60 days were prospectively recruited across different IBD Centers. Data for each colonic segment (sigmoid, descending, transverse, and ascending) were collected. Disease remission defined by endoscopy: Mayo Endoscopic subscore ≤1. IUS remission as per IBUS consensus: bowel wall thickness (BWT) 3.0 mm (average of 2 cross-sectional and 2 longitudinal measurements at least 1 cm apart) without the presence of color Doppler signals (CDS), inflammatory fat, or loss of echo stratification. An adapted definition (AD) of IUS remission was used for analysis in this elderly cohort (BWT 4.0 mm in the absence of CDS). The Milan Ultrasound Criteria (MUC) and IBUS-SAS were calculated for each bowel segment. Biomarkers within 60 days of endoscopy were recorded, including C-reactive protein (CRP, 5 mg/L) and fecal calprotectin (FCP, 250 μg/g). Diagnostic accuracy for IUS (sensitivity Sn, specificity Sp, positive predictive value PPV, negative predictive value NPV, and accuracy) was calculated using both definitions of remission. Optimal thresholds for predicting endoscopic remission were determined with ROC analysis. Results 34 elderly UC patients (99 colonic segments) were included. Colonoscopy and IUS were performed at a median of 19 (13-32) days apart. Endoscopic activity was documented in 24 (24.2%) colonic segments. (Table 1A). The Sn was identical across remission definitions; however, using AD improved the Sp, PPV, NPV, and accuracy for detecting IUS activity (Table 1B). ROC analysis demonstrated that IBUS-SAS (AUC 0.95 95% CI 0.91–0.99) and MUC (AUC 0.91 95% CI 0.86–0.97) performed better at discriminating endoscopic remission compared with BWT alone (AUC 0.88 95% CI 0.81–0.95). Optimal cut-offs for remission were 3.06 mm for BWT, ≤11.4 for IBUS-SAS, and ≤3.9 for MUC (Figure 1). Conclusion IUS demonstrates excellent diagnostic accuracy in an elderly UC cohort and represents a reliable non-invasive tool for disease assessment. An AD improved the Sp and accuracy of IUS. Larger studies are needed to validate these findings and explore if modifications to optimize IUS definitions for remission in UC in elderly populations are required. Conflict of interest: Dr. Ernest-Suárez, Kenneth: Consulting/Advisory Board fees: Abbvie, AstraZeneca, Johnson & Johnson, Pfizer, Ferring, Sandoz, SatisfAI, Takeda Speaker fees: Abbvie, AstraZeneca, Bayer, Johnson & Johnson, Ferring, Sandoz Calvo-Marin, Javier: Consulting/Advisory Board fees: Adium, AstraZeneca, NovoNordisk Speaker fees: Adium, AstraZeneca, Bayer, NovoNordisk, Viatris Umaña-Solis, Elizabeth: Speaker fees: Johnson & Johnson Parra Izquierdo, Leidy Viviana: None Orillac, Valeria: No conflict of interest Rettally, Carlos: No conflict of interest Cabral, Julia: Speaker fees: Abbvie, Johnson & Johnson Nuñez, Paulina: Speaker fees: Abbvie, Ferring, Johnson & Johnson, Takeda St-Pierre, Joelle: Consultant for Pfizer, Abbvie, Eli Lilly and Pendopharm, and speaker for Takeda. Novak, Kerri L.: Research Grants: Helmsley Trust, Pfizer, Janssen Adboard, consulting fees: Abbvie, Janssen, Pfizer, Pendopharm, Takeda, Elli Lilly, Celltrion, Bristal Myers Non financial support (ultrasound machine) McKesson Pharmcy. Pfizer, Celltrion Gozdzik, Michal: Speaker Fees: Pfizer, Johnson & Johnson Consultancy/Advisory Board Fees: Abbvie, Takeda, Celltrion, Ferring Educational grant: Pfizer Hoentjen, Frank: Frank Hoentjen has served on advisory boards or as speaker for Abbvie, CCRN, Janssen, Takeda, Pfizer, Celltrion, Teva, Amgen and Pendopharm, and has received independent research funding from Celltrion, Janssen, Abbvie, and Takeda. Lu, Cathy: Advisory board - Abbvie, JnJ, Takeda, Ferring, Merck, Celltrion, Pfizer Research Funding - Abbvie, JnJ
Ernest-Suárez et al. (2026) studied this question.