# Early intestinal ultrasound findings predict remission and treatment response at 1 year in pediatric Crohn’s disease

## TL;DR

Intestinal ultrasound can predict treatment response and remission in children with Crohn’s disease over one year.

## Contribution

This study shows that early intestinal ultrasound findings are strong predictors of long-term outcomes in pediatric Crohn’s disease.

## Key findings

- Bowel wall thickness at 6 months predicted 1-year remission with high sensitivity and specificity.
- Thicker bowel wall at 6 months was linked to a lower chance of remission.
- Intestinal ultrasound correlated strongly with endoscopic findings in pediatric patients.

## Abstract

Intestinal ultrasound (IUS) in pediatric IBD is increasing, but evidence remains limited compared with adults. This study aimed to evaluate the relationship between IUS and clinical, biochemical, and endoscopic measures in pediatric Crohn’s disease patients over 1 year, and to assess its ability to predict treatment response and remission.

Pediatric patients with suspected inflammatory bowel disease were prospectively enrolled and assessed over 1 year. Bowel wall thickness (BWT) and three validated IUS scores were calculated. Remission was combined clinical/biochemical/endoscopic remission. Treatment response was not needing therapy escalation and achieving remission by 1 year.

Sixty-one patients, median age 12.3 years (IQR 10.3-14.7; range 6-17), were included. IUS correlated moderately to strongly with endoscopy (rho 0.43-0.70). Thicker terminal ileum BWT was associated with increased likelihood of ileocecal resection (n = 7, 12%) (OR = 5.85, 95% CI 1.29-26.47, P < .05). Patients’ thickest bowel segment became significantly thinner at 1 month (P < .05). Thicker BWT at 6 months was associated with a decreased likelihood of 1-year remission (OR = 0.34; 95% CI 0.16-0.74, P = .006). BWT ≤ 2.8 mm at 6 months predicted treatment response with high sensitivity (73%) and specificity (84%). BWT ≤ 2.5 mm at 1 year predicted remission with high sensitivity (72%) and specificity (90%).

IUS correlated strongly with endoscopy in pediatric Crohn’s disease over 1 year, with increased BWT being associated with a higher risk of ileocecal resection and not achieving remission. Thickened (inflamed) bowel became significantly thinner as soon as 1 month. BWT in pediatric patients in remission was significantly lower (≤2.5 mm) than in adults (≤3–4 mm).