ABSTRACT Background Non‐invasive monitoring tools are needed in pediatric ulcerative colitis (UC) to reduce reliance on invasive procedures. The Milan ultrasound criteria (MUC), validated in adults, has not been evaluated in children. Methods In this exploratory pilot study, 16 pediatric UC patients (< 18 years) from two Colombian centers underwent intestinal ultrasound and endoscopy within a one‐month window (each performed up to one month before or after the other). MUC scores were calculated using bowel wall thickness and vascularization. Correlations with the pediatric ulcerative colitis activity index (PUCAI), Mayo endoscopic score (MES), the SPAUSS ultrasound score and inflammatory biomarkers were assessed, and the ability of MUC to identify active endoscopic disease (MES ≥ 2) was explored using ROC analysis. Results MUC correlated strongly with PUCAI ( ρ = 0.79, 95% CI 0.48–0.92, p < 0.001) and SPAUSS ( ρ = 0.90, 95% CI 0.73–0.97, p < 0.001). MUC scores were significantly higher in patients with active endoscopic disease (MES ≥ 2) than in those with inactive or mild disease (MES 0–1) (exact p < 0.001; rank‐biserial r = 1.00). In this small cohort MUC completely separated the two groups (AUC 1.00); at an exploratory cutoff of 4.85 sensitivity and specificity were both 100%, although with wide confidence intervals reflecting the limited sample size. These findings are hypothesis‐generating and require validation in larger cohorts. Conclusion In this pilot study, MUC showed promise as a simple non‐invasive tool to assess disease activity in pediatric UC; these preliminary findings warrant validation in larger studies before a pediatric cutoff can be recommended.
Izquierdo et al. (2026) studied this question.
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