Transrectal ultrasound in the diagnosis and management of inflammatory bowel disease

Background and Study Aims: To aim of the present study was to determine the value of transrectal ultrasonography (TRUS) in the assessment of disease a ctivity in ulcerative colitis patients, and in differentiating between muco sal inflammation and transmural inflammation, Patients and Methods: TRUS examinations were used to study 30 control indiv iduals and 76 patients with inflammatory bowel disease, including 50 cases of ulcerative colitis and 26 of Crohn's disease. A rigid linear endorectal probe was used to examine the rectal wall. Results: In the 30 control individuals, the rectal wall showed five layers, with a mean total diameter of 2.6 mm. There were significant differences b etween patients with quiescent ulcerative colitis, active ulcerative coliti s, and control individuals with regard to the total rectal wall thickness ( P<0.001), submucosal thickness (P<0.001) and mucosal thickness (P<0.001). U sing cut-off values, differentiation between active ulcerative colitis and remission ulcerative colitis was found to be 100% specific and 73% sensitiv e for submucosal thicknesses. TRUS revealed a 100% specificity in different iating between remission ulcerative colitis and control cases based on the total rectal wall thickness, submucosal, and mucosal thicknesses, In the di fferential diagnosis of active and remission ulcerative colitis, an increas e in submucosal wall thickness and the existence of arterial and venous cap illary flow in the submucosa were found to be specific and mole sensitive t han the other parameters. TRUS examination revealed transmural inflammation in 21 of the 26 Crohn's disease patients, and mucosal inflammation in all 50 of the ulcerative colitis patients. Conclusion: TRUS is a reliable and easy method of assessing ulcerative coli tis activity and differentiating between rectal diseases.