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      Point‐of‐care gastrointestinal ultrasound in inflammatory bowel disease: An accurate alternative for disease monitoring

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          Abstract

          Background and Aim

          Point‐of‐care ultrasound (POCUS) is a noninvasive alternative to ileocolonoscopy for monitoring disease activity in inflammatory bowel disease (IBD) but is underutilized in practice. Accuracy data are needed to engender clinician confidence in POCUS and increase uptake. The aim of this study was to evaluate the accuracy of POCUS compared to ileocolonoscopy in detecting active disease and extent in patients with IBD.

          Methods

          A prospective, blinded study was performed at a single tertiary center in South Australia between May 2017 and May 2018. Consecutive patients with a formal diagnosis of IBD who underwent both POCUS and ileocolonoscopy within 30 days of one another, performed to evaluate IBD disease activity, were eligible for participation. The accuracy of POCUS compared to ileocolonoscopy was assessed using sensitivity, specificity, and Cohen's kappa coefficient analyses.

          Results

          A total of 74 patients were included in the final analysis, 35 (47%) of whom had Crohn's disease and 39 (53%) ulcerative colitis; 37 subjects (50%) underwent a POCUS and ileocolonoscopy on the same day. POCUS demonstrated 91% sensitivity and 83% specificity for detecting endoscopically active IBD, correlating with a positive predictive value (PPV) of 89%, a negative predictive value (NPV) of 86%, and a kappa coefficient of 0.74 (88%). POCUS defined disease extent with 87% sensitivity and 81% specificity, correlating with a PPV of 85% and NPV of 83% and a kappa coefficient of 0.70 (85%).

          Conclusion

          POCUS is accurate in defining disease activity and extent in IBD compared to ileocolonoscopy. POCUS represents an appealing, noninvasive alternative to ileocolonoscopy for monitoring disease activity in IBD.

          Abstract

          Point of care ultrasound is incorporated into routine IBD assessment in many European centers, however uptake in Australia has been slow. This article evaluates the accuracy of point of care ultrasound in monitoring disease activity in a local cohort of IBD patients. Point of care ultrasound was found to be accurate for monitoring disease activity and extent in IBD compared to the gold standard, ileocolonoscopy.

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          Most cited references 25

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          The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications.

          In recent years, investigators have readdressed the complex issues involved in the classification of inflammatory bowel diseases. In 2003, a Working Party of investigators with an interest in the issues involved in disease subclassification was formed with the aim of summarising recent developments in disease classification and establishing an integrated clinical, molecular, and serological classification of inflammatory bowel disease. The results of the Working Party were reported at the 2005 Montreal World Congress of Gastroenterology. Here we highlight the key issues that have emerged from discussions of the Montreal Working Party and the relevance to clinical practice and research activities.
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            Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE): Determining Therapeutic Goals for Treat-to-Target.

            The Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) program was initiated by the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD). It examined potential treatment targets for inflammatory bowel disease (IBD) to be used for a "treat-to-target" clinical management strategy using an evidence-based expert consensus process.
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              Mucosal healing in inflammatory bowel disease: results from a Norwegian population-based cohort.

              Mucosal healing (MH) in inflammatory bowel disease may be an important sign of efficacy of treatment and a prognostic marker of long-term disease. The aim of the study was to examine both the possible predictors of mucosal healing and the impact of healing on subsequent course of disease. In 740 incident patients diagnosed with ulcerative colitis (UC) or Crohn's disease (CD) between 1990 and 1994 (before biologic therapy was available), demographics and symptoms were recorded. Clinical and endoscopic evaluations were done at baseline before treatment and repeated after 1 and 5 years in 495 patients. In UC patients, education longer than 12 years and extensive disease at diagnosis were significant predictors of MH after 1 year (adjusted P = .004 and P = .02, respectively). MH was significantly associated with a low risk of future colectomy (P = .02). In patients with CD, fever at diagnosis and medical treatment without steroids were significant predictors for MH (adjusted P = .03 and P = .01, respectively). MH was significantly associated with less inflammation after 5 years (P = .02), decreased future steroid treatment (P = .02). Several factors predicted subsequent MH. Education as predictor may implicate the importance of coping, compliance, or lifestyle. MH after 1 year of treatment is predictive of reduced subsequent disease activity and decreased need for active treatment. The present results give further strength to the use of mucosal healing as a clinical indicator and treatment goal in inflammatory bowel disease.
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                Author and article information

                Contributors
                dharshan.satha@gmail.com
                Journal
                JGH Open
                JGH Open
                10.1002/(ISSN)2397-9070
                JGH3
                JGH Open: An Open Access Journal of Gastroenterology and Hepatology
                Wiley Publishing Asia Pty Ltd (Melbourne )
                2397-9070
                09 October 2019
                April 2020
                : 4
                : 2 ( doiID: 10.1002/jgh3.v4.2 )
                : 273-279
                Affiliations
                [ 1 ] Gastroenterology Department Queen Elizabeth Hospital Adelaide South Australia Australia
                [ 2 ] School of Medicine The University of Adelaide Adelaide South Australia Australia
                Author notes
                [* ] Correspondence

                Dr Dharshan Sathananthan, Gastroenterology Department, Queen Elizabeth Hospital, Adelaide, 46a Anglesey Avenue, St Georges, South Australia, 5064 SA, Australia. Email: dharshan.satha@ 123456gmail.com

                Article
                JGH312269
                10.1002/jgh3.12269
                7144799
                © 2019 The Authors. JGH Open: An open access journal of gastroenterology and hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                Counts
                Figures: 2, Tables: 3, Pages: 7, Words: 4698
                Product
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                April 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.9 mode:remove_FC converted:09.04.2020

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