University of Chicago Medicine, Inflammatory Bowel Disease Center Chicago, IL
Award: Presidential Poster Award
Noa Krugliak Cleveland, MD1, Yusuke Miyatani, MD1, Emma A. Picker, BA1, David T. Rubin, MD2 1University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL; 2Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL
Introduction: Intestinal ultrasound (IUS) is a non-invasive monitoring tool with high diagnostic accuracy for disease activity in ulcerative colitis (UC). To maximize the strength of repeatable exams by IUS, self-performed IUS might be useful as monitoring strategy. Here, we report the first case using a handheld ultrasound by a non-medically trained patient to monitor UC in real-time during induction therapy for severe colitis.
Case Description/Methods: A 32-year-old man with a 3-year history of medically refractory ulcerative pancolitis presented to our center for management. He was recently admitted to the hospital for induction therapy with cyclosporine and achieved clinical remission. However, his UC relapsed during transition to azathioprine maintenance. Subsequently, we initiated upadacitinib. At baseline, IUS was performed by our team using a stationary ultrasound machine while on upadacitinib. The patient was subsequently instructed on the use of a handheld portable ultrasound device that enables Bluetooth® connection to a personal electronic device and instructed on how to visualize the sigmoid colon and measure bowel wall thickness (BWT) and vascularization using color Doppler signal (CDS). Images taken by the patient and Simple Clinical Colitis Activity Index score were transmitted securely to our team. Over the course of the first week, we reviewed the obtained images and provided feedback to him with subsequent highly accurate measurements by the patients. His colitis symptoms and measures on the handheld IUS scans over the course of the next three weeks did not improve. After a surgical consultation, he preferred a second attempt at cyclosporine, with plan for transition to a different maintenance therapy. Despite clinical improvement with the cyclosporine, he had persistent symptoms and the handheld IUS identified worsening BWT during the following month. The patient was subsequently switched to infliximab with plan for proctocolectomy had this treatment fails.
Discussion: This self-performed handheld IUS monitoring strategy not only provided valuable and timely medical information for making decisions about his next treatment course, but also allowed the patient to feel more comfortable with his treatment and better understand his colitis. Further studies are needed to assess the utility of self-performed IUS before they incorporation into clinical practice.
Figure: Intestinal ultrasound images of the sigmoid colon with measurements of bowel wall thickness and color Doppler signal self-performed by the patient (A, B) using a hand-held ultrasound and by the physician (NKC) (C, D) using a stationary ultrasound machine.
Emma Picker indicated no relevant financial relationships.
David Rubin: AbbVie – Consultant, personal fees. AltruBio – Consultant, personal fees. Aslan Pharmaceuticals – Consultant. Athos Therapeutics – Consultant. Bellatrix Pharmaceuticals – Consultant. Boehringer Ingelheim – Consultant, personal fees. Bristol Myers Squibb – Consultant. Celgene Chronicles – Consultant. ClostraBio – Consultant. Connect BioPharma – Consultant. Corp/Syneos – Consultant. Eco R1 – Consultant. GastroIntestinal Research Foundation – Grant/Research Support. Genentech/Roche – Consultant. Gilead Sciences – Consultant, personal fees. Helmsley Charitable Trust – Grant/Research Support. Iterative Health – Consultant. Janssen Pharmaceuticals – Consultant, personal fees. Kaleido Biosciences – Consultant. Lilly – Consultant. Pfizer – Consultant, personal fees. Prometheus Biosciences – Consultant. Reistone Biopharma – Consultant, personal fees. Seres Therapeutics – Consultant. Takeda – Consultant, Grant/Research Support, Personal fees. Target RWE – Consultant. Trellus Health – Consultant.
Noa Krugliak Cleveland, MD1, Yusuke Miyatani, MD1, Emma A. Picker, BA1, David T. Rubin, MD2. P3660 - Disease Monitoring by Self-Performed Handheld Intestinal Ultrasound in Severe Ulcerative Colitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
