What does this research mean for the field?

Intestinal ultrasound (IUS), particularly bowel wall thickness (BWT) assessment, accurately predicts steroid response in patients with severe ulcerative colitis. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To assess the accuracy of intestinal ultrasound in predicting treatment response and outcomes for severe ulcerative colitis patients.

February 16, 2026Open Access

Poster Session II – Poster of Distinction II - A210 PREDICTIVE VALUE OF INTESTINAL ULTRASOUND FOR TREATMENT RESPONSE AND LONG-TERM OUTCOMES IN SEVERE ULCERATIVE COLITIS: A SYSTEMATIC REVIEW

Key Points

To assess the accuracy of intestinal ultrasound in predicting treatment response and outcomes for severe ulcerative colitis patients.
Conducted a comprehensive electronic search across Medline, Embase, and Cochrane databases
Included prospective cohort studies and randomized controlled trials
Synthesis of diagnostic test accuracy data using a bivariate random-effects model
Pooled odds ratios for predictors of nonresponse using a random-effects model
Meta-analysis indicated a sensitivity of 0.83 and specificity of 0.77 for predicting steroid response based on bowel wall thickness reduction
Positive likelihood ratio of 3.66 and negative likelihood ratio of 0.22, suggesting strong predictive utility
Bowel wall thickness greater than 4.0 mm correlated with a high odds ratio of 9.5 for requiring colectomy
A bowel wall thickness reduction of less than 2 mm was associated with an odds ratio of 3.8 for colectomy risk

Abstract

Abstract Background Intestinal ultrasound (IUS) is an emerging non-invasive modality for real-time monitoring in ulcerative colitis (UC). Its role in predicting treatment response and long-term outcomes in severe UC remains underexplored. Aims To evaluate the accuracy of IUS - particularly bowel wall thickness (BWT), in predicting treatment response and future outcomes in patients with severe UC. Methods A comprehensive electronic search was conducted on Medline, Embase and Cochrane through December 2024 to identify prospective cohort studies and randomized controlled trials (RCTs). Primary outcome was the predictive accuracy of ≥ 20% reduction in bowel wall thickness. Secondary outcomes included colectomy rates and steroid response using BWT thresholds (1–2 mm reduction). Diagnostic test accuracy (DTA) data were synthesized using a bivariate random-effects model (Meta-DiSc 2.0). Odds ratios (ORs) for predictors of nonresponse were pooled using a random-effects model (RevMan 5.4.1) Results Four studies were included from 5403 citations reporting outcomes in terms of steroid response and/or need for colectomy. Meta-analysis of two studies assessing a ≥ 20% reduction in BWT showed a sensitivity of 0.83 (95% CI 0.67–0.92) and specificity of 0.77 (95% CI 0.64–0.87) for predicting steroid response. Positive and negative likelihood ratios were 3.66 (95% CI: 1.76–5.56) and 0.22 (95% CI: 0.06–0.39), respectively, indicating strong rule-in and rule-out utility. One study reported that BWT 4.0 mm was associated with an OR of 9.5 (95% CI: 1.5–186) for colectomy at 3 months. A BWT reduction 2 mm was associated with an OR of 3.8 (95% CI: 0.6–75) for colectomy Conclusions IUS, particularly BWT assessment, demonstrates promising diagnostic accuracy for predicting steroid response in severe UC and may aid in early identification of patients at risk of treatment failure. Although early data suggest potential in predicting colectomy risk, current evidence is limited by heterogeneity and small sample sizes. Larger, prospective studies are needed to confirm the utility of IUS in long-term risk stratification and treatment optimization Funding Agencies None

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