{"doi":"10.1002/ueg2.12215","title":"Ulcerative colitis, a transmural disease requiring an accurate IUS assessment in the current treat‐to‐target era","abstract":null,"journal":"United European Gastroenterology Journal","year":2022,"id":637596,"datarank":0.3596842909197557,"base_score":2.3978952727983707,"endowment":2.3978952727983707,"self_citation_contribution":0.3596842909197557,"citation_network_contribution":0.0,"self_endowment_contribution":0.3596842909197557,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":10,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":646300,"name":"Bram Verstockt","orcid":"0000-0003-3898-7093","position":1,"is_corresponding":false},{"id":676698,"name":"Michael T. Dolinger","orcid":"0000-0002-9023-4948","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Ulcerative colitis, a transmural disease requiring an accurate IUS assessment in the current treat‐to‐target era","abstract":"Ulcerative colitis (UC) has been classically deemed a mucosal disease and as such, assessment by colonoscopy is considered the gold standard to monitor disease activity.1 The STRIDE-II guidelines established a treat-to-target goal for UC patients to achieve mucosal healing within 6 months after the start of a new therapy.2 However, timely treat-to-target assessment by colonoscopy is frequently foregone by patients due to its invasive nature, especially during the COVID-19 pandemic, and as such, reliable, non-invasive, patient-centric biomarkers and monitoring tools are needed to evaluate UC disease activity. In the current study, Alloca et al. again confirmed the accuracy of intestinal ultrasound (IUS) compared with colonoscopy: baseline Milan Ultrasound Criteria (MUC) correlated significantly with a Mayo endoscopic sub-score (ρ = 0.65, p < 0.001).3-5 While this study supports the integration of IUS into the treat-to-target algorithm for UC as a patient-friendly, non-invasive tool that may substitute colonoscopy, a significant limitation remains that transabdominal IUS is unable to accurately assess the rectum (in contrast to perianal ultrasound). Thus, transabdominal IUS is not an ideal monitoring tool for patients with a history of ulcerative proctitis alone, unless it is used purely to assess disease extension. Another common critique of IUS has been a lack of reliability, but inter-observer agreement has recently been shown to be excellent for UC, providing further evidence supporting intestinal ultrasound as a non-invasive monitoring tool.6 Responsiveness of IUS scores to treatment in UC remain a significant unknown that requires further investigation, including the proper timing of repeat IUS to assess treatment response and adjust therapy. Results from the multicenter TRUST&UC study demonstrated improvement in IUS parameters such as bowel wall thickness (BWT) and hyperemia as early as 2 weeks after treatment initiation.7 However, no externally validated IUS score - such as the MUC - was available at the time of the TRUST&UC study and thus, there exist no data to examine the predictive value of early change in MUC to predict long-term outcomes. Achievement of deep remission using this treat-to-target approach in Crohn's disease has shown to prevent disease progression in a post-hoc analysis of the CALM trial,8 but this has not yet been shown prospectively in UC. Yet, as our understanding of involvement beyond the mucosa in UC evolves, the importance of achieving transmural healing in UC may become clearer.9 The current study by Allocca et al. sheds light on this,3 and provides the first evidence of the utility of a validated transmural ultrasound score to predict disease progression in UC. The key findings of this study are the ability of a MUC score >6.2 to predict a negative disease course (Hazard Ratio [HR] 3.87, 95% confidence interval [CI] 2.25–6.64). Nine patients during the study were hospitalized for severe flare and a MUC > 6.2 was strongly predictive, with eight patients hospitalized with a MUC > 6.2, compared to only one with a MUC ≤ 6.2 (HR 7.20, 95% CI 0.88–58.83). This study also confirmed the utility of MUC to predict colectomy with seven patients with a MUC > 6.2 undergoing colectomy, compared to none with a MUC ≤ 6.2. However, dynamics in BWT and vascularization upon treatment initiation (with a potential reduction in the MUC score) might further improve the prognostic accuracy, as not every patient with a MUC > 6.2 will eventually require colectomy. This single-center study using a simple, easily calculated, real-time IUS score demonstrates that baseline transmural assessment can be utilized to predict disease progression in UC patients. The use of the MUC at baseline to determine disease course and potentially stratify treatment strategies might be an initial step to our understanding how transmural targets in UC can be utilized to potentially alter the disease course. The ability of the MUC to capture and predict disease progression in UC at baseline is a significant advancement in understanding the role of non-invasive monitoring tools and the transmural nature of UC. This study will inspire future studies to understand the impact of patient friendly, non-invasive tools and how early transmural treatment response, or lack thereof, may predict long-term outcomes for UC patients. Michael Dolinger is not supported by any research grant funding. Bram Verstockt is supported by the Clinical Research Fund (KOOR) at the University Hospitals Leuven. Michael Dolinger reports consultancy fees from Neurologica Corp. Bram Verstockt reports research support from Pfizer; speaker's fees from Abbvie, Biogen, Bristol Myers Squibb, Chiesi, Falk, Ferring, Galapagos, Janssen, MondayNightIBD, MSD, Pfizer, R-Biopharm, Takeda, Truvion and Viatris; consultancy fees from Alimentiv, Applied Strategic, Atheneum, Bristol Myers Squibb, Galapagos, Guidepont, Ipsos, Janssen, Progenity, Sandoz, Sosei Heptares and Takeda. Data sharing not applicable – no new data generated, or the article describes entirely theoretical research.","is_dataset_classified":null,"base_score":2.1972245773362196,"endowment":2.1972245773362196,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"35230746","pmcid":"PMC9004240","openalex_id":"https://openalex.org/W4214671502","authors":[],"funders":[],"total_grants":0,"fwci":1.3447,"citation_percentile":0.80712807,"influential_citations":0,"citation_trend":[{"year":2024,"count":5},{"year":2025,"count":3}],"oa_status":"bronze","license":"http://onlinelibrary.wiley.com/termsAndConditions#vor","oa_locations":[{"url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/ueg2.12215","host_type":"journal"},{"url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/ueg2.12215","host_type":"publisher"},{"url":"https://onlinelibrary.wiley.com/doi/pdf/10.1002/ueg2.12215","host_type":"publisher"},{"url":"https://onlinelibrary.wiley.com/doi/full-xml/10.1002/ueg2.12215","host_type":"publisher"},{"url":"https://doi.org/10.1002/ueg2.12215","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/35230746","host_type":"repository"},{"url":"https://lirias.kuleuven.be/handle/20.500.12942/703297","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/9004240","host_type":"repository"}],"fields_of_study":["Inflammatory Bowel Disease","Microscopic Colitis","Colorectal Cancer Screening and Detection","Colitis, Ulcerative","Humans","Inflammatory Bowel Diseases"],"mesh_terms":["Colitis, Ulcerative","Humans","Inflammatory Bowel Diseases"],"keywords":["Medicine","Colonoscopy","Ulcerative colitis","Disease","Proctitis","Gold standard (test)","Internal medicine","Ultrasound","Rectum","Inflammatory bowel disease","Gastroenterology","Surgery","Radiology","Colorectal cancer","Cancer"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-06T19:13:04.496083Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}