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Combined use of intestinal ultrasound examination and fecal calprotectin testing can identify mucosal healing in most patients with ulcerative colitis.

The combination of intestinal ultrasound (IUS) examination and fecal calprotectin testing can effectively identify mucosal healing in most patients with ulcerative colitis (UC), according to a study published in Inflammatory Bowel Diseases.

“The combination of a normal IUS, no rectal bleeding, and an FC [fecal calprotectin] <172 µg/g identified all patients with mucosal healing,” researchers wrote.

The study evaluated IUS and measurement of fecal calprotectin, both alone and in combination, as noninvasive alternatives to endoscopic examinations for assessing mucosal healing. Researchers assessed 61 consecutive patients with UC who underwent a complete colonoscopy as well as IUS, fecal calprotectin testing, or both within 4 weeks of colonoscopy.

Bowel wall thickness and color Doppler signal (CDS) were assessed for each bowel segment during ultrasound examination. If the bowel wall thickness was less than 3 mm, and if rich vascular enhancement of the bowel wall was absent for all segments per CDS assessment, the ultrasound examination findings were considered normal. Researchers defined mucosal healing as a Mayo score of 0 or 1.

Combination Reliably Identifies Abnormal Results

Seventy-nine percent of patients showed endoscopic healing on colonoscopy: 26 patients had a Mayo score of 0, and 11 had a score of 1, researchers reported.

For predicting endoscopic mucosal healing, bowel wall thickness less than 3 mm showed a sensitivity of 37%, specificity of 77%, positive predictive value of 72%, and negative predictive value of 44%, according to the study. Bowel wall thickness less than 3 mm combined with a normal fecal calprotectin level of less than 150 µg/g and no CDS had a sensitivity of 33%, specificity of 94%, positive predictive value of 89%, and a negative predictive value of 48%.

The study included a pair of algorithms for monitoring patients with UC: one that integrates fecal calprotectin, IUS examination, and symptoms and another that initially excludes fecal calprotectin due to its low acceptability and cost in some countries.

“[T]he combination of rectal bleeding and a normal IUS never failed to identify patients with an abnormal endoscopy,” researchers wrote. “In the other clinical scenario, using calprotectin in combination with IUS would correctly identify disease activity in 84% of patients. Endoscopy would still only be needed for 10% of patients.”