GI ultrasound underused for IBD, say gastroenterologists

IBD

By Michael Woodhead

22 Feb 2018

Gastrointestinal ultrasound is potential game changer in the diagnosis and management of IBD but is widely lamentably underused, according to Australian gastroenterologists.

While the imaging modality is in common use as a point of care test to assess mucosal healing by gastroenterologists in Europe, it has yet to take off in countries such as Australia, they write in Gut.

As a non-invasive and radiation free test that is easily accessible, GI ultrasound could be a convenient adjunct to endoscopy and CT scans for diagnosing and monitoring inflammatory bowel conditions, according to a review authored by Adelaide-based Dr Rob Bryant and five other Australian gastroenterologists including Professor Peter Gibson of Monash University.

They emphasise that GI ultrasound is not being proposed to replace endoscopy, but could be a more accessible complementary method for initial assessment and monitoring of a patients response to treatment.

GI ultrasound has been shown to accurately discriminate between inflammatory and non-inflammatory pathology in patients with abdominal pain and diarrhoea, with a sensitivity of 80-90% and a specificity of 94-97.8%, they note.

“[It] is accurate in diagnosing IBD, detecting complications of disease including fistulae, strictures and  abscesses, monitoring disease activity and detecting postoperative disease recurrence,” they write

And since it can be done in real time at the point of care, GI ultrasound offers the potential to expedite decision making and help triage patients for further investigations and treatments.

The procedure would be particularly suited to use in children and for patients who required repeated investigations where endoscopy and CT scans would be impractical, they suggest.

“Maximal benefit of GI ultrasound is derived from point-of-care ultrasound performed by a member of the gastroenterology team delivering IBD care,” they say, adding that it could also have a useful role when performed as a stand alone service in the department or within the radiology department.

The limitations of GI ultrasound are that it may be less accurate in obese people and more difficult to identify inflammation in areas such as the rectum or the pelvis due to anatomical constraints.

Nevertheless, international groups increasingly recognise GI ultrasound as “a valuable tool with paradigm-changing application in the management of IBD,” the authors say.

One of the  main barriers to uptake of GI ultrasound among gastroenterologists has been the lack of training framework, and guidelines for incorporation into clinical practice, they noted.

However, this was now being remedied by groups such as the International Bowel Ultrasound Group.

“Despite a prior lack of ultrasound experience, gastroenterologists are equipped with the knowledge and dexterity to rapidly acquire competency in GI ultrasound,” they suggest.

“GIUS is a valuable non-invasive tool in the management of IBD that has the potential to shift clinical practice paradigms,” they conclude, “[but] a co-ordinated approach at a national level is required.”

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