Nearly three million people in the United States have inflammatory bowel disease (IBD), a group of chronic conditions (including Crohn’s disease and ulcerative colitis) that cause inflammation in the gastrointestinal tract. Since IBD is a lifelong condition, patients with IBD need to work closely with their doctors and care teams to create a treatment plan that reduces inflammation and improves symptoms.
Doctors in Europe, Australia, and Canada have been using technology called intestinal ultrasound (or point-of-care ultrasound) for decades to help improve patient education and management of the condition. However, the technology has only recently gained traction in the United States. Yale New Haven Hospital is the first organization in Connecticut to offer point-of-care ultrasound (POCUS) for IBD care and is one of only a handful of places using the technology in the northeast region.
We spoke with Jill Gaidos, MD, associate professor of medicine (digestive diseases) and medical director of the Yale Inflammatory Bowel Disease Program, about how intestinal ultrasound enhances patient care, supports physician education, and enables research.
How does intestinal ultrasound change the way you care for patients with IBD?
When we care for patients with IBD, we need regular testing to understand what is happening within the patient’s intestines. Testing can include colonoscopies, stool testing, MRIs, or CT scans. These tests can be inconvenient or uncomfortable for patients, and it can take time to get test results, which can delay changes to treatment.
Intestinal ultrasounds take the place of some of that testing. While the patient is in the clinic, I can put an ultrasound probe on their abdomen to evaluate their intestines and look for signs that suggest active inflammation or remission. It can also help me see complications, like strictures or abscesses.
Because the patient is awake, I can show them what I’m looking at on the screen so they have a much better understanding of what’s going on with their intestines right at that moment, too.
If a patient has minimal symptoms but a lot of inflammation, they can better understand that they need to be on medicine even though they feel okay. If a patient has active symptoms but no inflammation, seeing the image helps them understand that we don’t need to change their IBD medications. Instead, we can look for other treatments to treat symptoms that are not related to their IBD.
What training do physicians need to use intestinal ultrasound for IBD care?
The International Bowel Ultrasound Group (IBUS) has a year-long training program and certification for gastroenterologists who care for patients with IBD. The training includes three modules. The first includes mostly lectures and some hands-on experience. The second module is all hands-on training at an expert center. The final module is an advanced workshop with additional lectures. After you complete the training, you must pass a written test to become IBUS certified.
I received my IBUS certification last year, and we have plans for the rest of our IBD team to become certified soon.
We are also happy to be able to offer this technology to the fellows in our advanced IBD fellowship program. We are encouraging all our fellows to complete the first module and then practice using the machine in our IBD clinic. Like anything in life, it’s important to use what you’ve learned so that it stays fresh in your mind.
Can intestinal ultrasound detect other intestinal problems?
Right now, we only use intestinal ultrasound for IBD care. However, the technology has been useful to help rule out an IBD diagnosis for certain patients.
For example, the digestive symptoms of irritable bowel syndrome (IBS) and IBD can be similar. If a patient comes to the clinic with symptoms like abdominal pain and cramping, bloating, constipation, and diarrhea, we can do an intestinal ultrasound to see if there’s any inflammation. If we don’t see any inflammation at all, we can often rule out IBD as a diagnosis.
Can intestinal ultrasound help facilitate research?
Absolutely. Many IBD studies require patients to undergo multiple colonoscopies as part of the clinical trial. For instance, in one study we participate in, patients must get three colonoscopies in a year. While many patients would like to participate in a trial, many are deterred by the prospect of having three colonoscopies in such a short time period.
If you could instead substitute even one or two colonoscopies with an intestinal ultrasound performed in the office, it would significantly cut the cost of research, reduce the burden on patients, and help us increase recruitment.
Several clinical trial organizations have already started incorporating intestinal ultrasound into their protocols, and I hope others will follow suit.
Since forming one of the nation’s first sections of hepatology more than 75 years ago and then gastroenterology nearly 70 years ago, Yale School of Medicine’s Section of Digestive Diseases has had an enduring impact on research and clinical care in gastrointestinal and liver disorders. To learn more about their work, visit Internal Medicine: Digestive Diseases.