Global 
Deutschland Colon to Rectum
Inflamm Bowel Dis. 2026;32(5):938-944
Early intestinal ultrasound assessment predicts therapy response: An easy tool for clinical decision-making
Background: Transmural healing (TH) has emerged as a therapeutic target in Crohn’s disease (CD), providing a more comprehensive indicator of deep remission than mucosal healing alone. Intestinal ultrasound (IUS) is a noninvasive method for assessing TH, but its prognostic value remains insufficiently defined.
Objective: The aim of this prospective study was to evaluate whether early improvement in IUS parameters during biological therapy could predict TH at 12 months.
Design: This is a prospective multicenter study enrolling CD patients initiating biological therapies. IUS and Doppler parameters were assessed at baseline, 3 months, and 12 months. Delta (Δ) represented the variation in ultrasound measurements between baseline and 3 months. TH was defined as normalization of bowel wall features and absence of hypervascularization.
Results: A total of 142 CD patients were included. At 12 months, the TH rate was 19%, the IUS response rate was 44%. Patients achieving TH showed a significantly greater delta bowel wall thickening (ΔBWT) than nonresponders (p = 0.0004). On ROC analysis, a ΔBWT reduction of 1.25 mm predicted TH with 73% sensitivity and 61% specificity. IUS responders had a significantly greater ΔBWT than nonresponders (p < 0.0001), with the same threshold predicting response with 83% sensitivity and 57% specificity. Notably, the combination of ΔBWT and Limberg score improvement was strongly associated with both TH (OR = 13.26; p < 0.0001) and IUS response (OR = 20.9; p < 0.0001) at 12 months.
Conclusion: Early reduction in BWT, especially when combined with Limberg score, is a strong predictor of TH and IUS response at 12 months, supporting the use of early IUS monitoring in clinical practice.
DOI: 10.1093/ibd/izaf317