A/Prof Antony Friedman
Gastroenterologists at the Alfred Hospital and Monash University, Melbourne, say their experience with point-of-care ultrasonography in outpatient consultations supports its incorporation into routine management of patients with IBD.
Use of ultrasound in IBD clinics improved clinician decision-making and enhances patients’ understanding of their disease, their study showed.
In a paper published in Alimentary Pharmacology and Therapeutics they said the noninvasive technique had shown clinical benefits in the diagnosis, assessment of complications and follow-up of the patients with Crohns Disease and ulcerative colitis. Ultrasound has also proved to be a useful educational tool for patients, encouraging medication adherence.
In a prospective, observational cohort study Associate Professor Antony Friedman and colleagues assessed the experiences of treating gastroenterologists and 73 adult IBD patients who underwent gastrointestinal ultrasound.
The mean age of patients was 40 years, 54% were male, and the average time since diagnosis was 9.2 years (ultrasound). The impact of ultrasound for patients was assessed immediately after their clinic visit and at 4 and 16 weeks.
The study showed that after ultrasound, the clinician’s assessment of patient’s disease activity changed in 22% of patients and management was altered in 56% of patients, with anti-inflammatory therapy escalated in 45%.
About 47% patients with Crohn’s disease had their medication changed in the ultrasound group, compared to only 22% in a control group of 112 patients who did not have ultrasound group (P = 0.002).
For patients with ulcerative colitis, medications were altered in 68% compared to 26% in the non-ultrasound group (P = 0.005) When stratified for disease activity, medication change was more likely in those having ultrasound.
From the patients perspective, those who self-reported active disease reported better understanding of all aspects of their disease and disease symptoms immediately after undergoing ultrasound, although the effect was not seen at 16 weeks after the consultation.
Patients who underwent ultrasound reported being more confident in their ability to make informed decisions about managing their disease and had improved knowledge domain scores compared with the non-ultrasound group.
There was also a trend amongst patients who underwent ultrasound in the clinic to report less medication nonadherence over time, with the study investigators noting that adherence was variable at baseline, and only 60% for biologics.
However, medication adherence reduced over time in both ultrasound and non-ultrasound groups.
The study investigators said the results supported previous research that point-of-care gastrointestinal ultrasound performed by gastroenterologists contributed to clinical decision-making. It had also provided preliminary data to suggest that ultrasound “might also be incorporated into disease assessment algorithms to support decisions regarding management strategies for patients with IBD,” they added.
“Overall, gastrointestinal ultrasound provides a valuable, inexpensive and noninvasive tool that may contribute to improved outcomes for patients with IBD,” they concluded.