title: Use of Intestinal Ultrasound to Monitor Crohn's Disease Activity.
abstract: OBJECTIVE
  We performed a multicenter study to determine whether transabdominal bowel wall ultrasonography, a noninvasive procedure that does not require radiation, can be used to monitor progression of Crohn's disease (CD).
  
  
  METHODS
  We performed a 12-month prospective, noninterventional study at 47 sites in Germany, from December 2010 through September 2014. Our study included 234 adult patients with CD who experienced a flare, defined as Harvey-Bradshaw index score of ≥7. All patients received treatment intensification, most with tumor necrosis factor antagonists. Ultrasound parameters and clinical data were assessed at baseline and then after 3, 6, and 12 months. The primary endpoint was the change in ultrasound parameters within 12 months of study enrollment.
  
  
  RESULTS
  All patients included had bowel wall alterations either within the terminal ileum and/or segments of the colon. After 3 and 12 months, ultrasonographic examination showed significant improvements of nearly all ultrasound parameters, including reductions in bowel wall thickening or stratification, decreased fibrofatty proliferation, and increased signals in color Doppler ultrasound (P < .01 for all parameters at months 3 and 12). Median Harvey-Bradshaw index scores decreased from 10 at baseline to 2 after 12 months. Improvement in bowel wall thickness correlated with reduced levels of C-reactive protein after 3 months (P ≤ .001).
  
  
  CONCLUSIONS
  In a multicenter prospective study, we found that ultrasonographic examination can be used to monitor disease activity in patients with active CD. Bowel ultrasonography seems to be an ideal follow-up method to evaluate early transmural changes in disease activity, in response to medical treatment. German Clinical Trials Register: drks.de/DRKS00010805.
authors.affiliation: Department of Internal Medicine and Gastroenterology, University Teaching Hospital Lüneburg, Lüneburg, Germany. Electronic address: torsten.kucharzik@klinikum-lueneburg.de.
authors.forename: Torsten
authors.initials: T
authors.lastname: Kucharzik
authors.affiliation: Medical Department, AbbVie Deutschland GmbH & Co, KG, Wiesbaden, Germany.
authors.forename: Bianca M
authors.initials: BM
authors.lastname: Wittig
authors.affiliation: Gastroenterology Practice, Oldenburg, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Helwig
authors.affiliation: Gastroenterology Practice, Mainz, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Börner
authors.affiliation: Medical Department, AbbVie Deutschland GmbH & Co, KG, Wiesbaden, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Rössler
authors.affiliation: Medical Department, AbbVie Deutschland GmbH & Co, KG, Wiesbaden, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Rath
authors.affiliation: Ambulanzzentrum Gastroenterologie, University Teaching Hospital Lüneburg, Lüneburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Maaser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology*; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D005858:Germany; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007422:Intestines / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
chemical_list: D007155:Immunologic Factors
keywords: Intestinal Ultrasound; Limberg Score; TRUST Study; Vascularization