Monitoring inflammatory bowel disease (IBD) in children presents a significant challenge for young patients and their families, as well as for medical professionals. The chronic nature of conditions like Crohn's disease and ulcerative colitis requires regular monitoring of the intestinal condition to ensure effective treatment and prevent long-term complications. Traditional monitoring methods, such as magnetic resonance imaging (MRI) and endoscopy (colonoscopy), although crucial for diagnosis and assessment, are often invasive, uncomfortable, require special preparations, and sometimes anesthesia, which can be particularly frightening and burdensome for children.

Fortunately, advances in medical technology are bringing new, less invasive approaches. One such innovation promising to revolutionize the monitoring of pediatric IBD is intestinal ultrasound (IUS), also known as bowel ultrasound. This method is becoming increasingly available and proves to be an extremely valuable tool in the hands of gastroenterologists.

A new approach to monitoring IBD in children

UCSF Benioff Children’s Hospitals recently announced the introduction of intestinal ultrasound at their clinic in Walnut Creek (find accommodation options here), making it one of the few institutions on the West Coast of the United States offering this advanced diagnostic method to pediatric patients. This move follows the successful introduction of IUS for adult patients with IBD within the UCSF Health system during 2023, where it proved extremely useful.

Intestinal ultrasound uses high-frequency sound waves to create detailed real-time images of the walls of the small and large intestines. The physician moves a gel-coated probe across the patient's abdomen, and the images are immediately displayed on a screen. The entire procedure typically takes between 10 and 30 minutes, is painless, and requires no special preparation – no need for fasting, drinking unpleasant bowel cleansing fluids (so-called "bowel prep"), intravenous contrast, or sedation or anesthesia.

Advantages of intestinal ultrasound in pediatrics

Compared to traditional methods, the advantages of IUS are numerous, especially in the pediatric population:

• Non-invasiveness and painlessness: The procedure is completely painless and requires no needles or medications. Mild pressure from the probe on the abdomen may be felt.


• No radiation: Unlike CT scans, IUS does not use ionizing radiation, making it safe for repeated use, especially in children who are more sensitive to the long-term effects of radiation.


• No preparation and sedation: It eliminates the need for often uncomfortable bowel preparations and the risks associated with anesthesia, reducing stress for the child and parents and facilitating the logistics of the examination.


• Real-time results: The physician and patient (and parents) can see the bowel images on the screen immediately. This allows for instant assessment of the condition and quick decisions about further treatment, without waiting for radiological or pathological findings.


• Convenience: The examination can be performed directly in the clinic during a regular visit to the gastroenterologist, eliminating the need for separate appointments in radiology and reducing waiting times.


• High accuracy: Research shows that IUS is very precise in assessing disease activity, measuring bowel wall thickness (a key indicator of inflammation – thickness greater than 3 mm is considered abnormal), assessing blood flow (using Doppler technique, where increased blood flow indicates active inflammation), and detecting complications such as narrowing (strictures), abnormal channels (fistulas), or pus collections (abscesses). Its sensitivity and specificity are comparable to endoscopy and MR enterography for many aspects of IBD assessment.

Patient and physician experience

Dhiya Ravikumar, a long-term patient at UCSF Health diagnosed with Crohn's disease at age 10, had the opportunity to try intestinal ultrasound. Her experience highlights the benefits of the new method. "MRI is claustrophobic, and with endoscopy, you have to drink all that liquid and go under anesthesia, which is scary," Dhiya shared. "But the ultrasound was convenient and painless, and we could see the results on the screen right away." For Dhiya, who now actively plays tennis on her school team, it's a relief to know there is a simpler and faster way to monitor her condition, allowing her to dedicate more time to the activities she loves.

Dr. Sabina Ali, medical director of the Inflammatory Bowel Disease Program at UCSF Benioff Children's Hospital Oakland (check accommodation availability in Oakland), confirms the huge benefit of IUS. "This has been incredibly helpful for patients and their families – no prep for the scan, no loud machines, no IV lines placed – and it can all be done right there in the exam room," Dr. Ali points out. "It also helps cut down on wait times because there’s virtually no setup time needed."

Application of IUS in the management of pediatric IBD

Inflammatory bowel diseases, which include Crohn's disease and ulcerative colitis, are characterized by chronic inflammation of the digestive tract. Symptoms often include diarrhea (sometimes bloody), abdominal pain, weight loss, fatigue, and in children, can significantly affect growth and development. Since the course of the disease varies and treatment often requires adjustments – from changing medications to dietary interventions – regular and precise monitoring is crucial for successful long-term management.

Intestinal ultrasound is used in several key aspects of care for children with IBD:

• Monitoring disease activity: Allows regular checks of the degree of bowel inflammation without the need for invasive procedures.


• Assessing response to therapy: Physicians can quickly evaluate whether a new medication or change in treatment is working, enabling timely adjustments to the therapeutic plan. Studies show that response to some rapid biologic therapies can be detected within 24-48 hours.


• Detecting complications: IUS can identify strictures, fistulas, and abscesses, which is important for planning further treatment, including potential surgical intervention.


• Post-operative monitoring: Used to check for early signs of disease recurrence after surgical removal of part of the bowel.


• Emergency evaluations: It is an excellent tool for rapid assessment in patients experiencing a sudden worsening of symptoms or requiring an urgent change in treatment.


• Supporting diagnosis: Although endoscopy with biopsy remains the gold standard for making an initial diagnosis of IBD, IUS can serve as a valuable screening tool and help differentiate IBD from other conditions with similar symptoms.

Although intestinal ultrasound cannot completely replace endoscopy, especially for initial diagnosis, detection of very small lesions, or screening for dysplasia (precancerous changes), its ability for frequent, safe, and non-invasive monitoring of inflammation makes it an extremely valuable addition to the care of children with IBD. The introduction of this technology in centers like UCSF Benioff Children's Hospital represents a significant step forward in improving the quality of life for young patients, reducing the burden of the disease, and allowing them, like Dhiya, to dedicate more time to childhood and the activities that bring them joy.

Source: University of California