Intestinal ultrasound [IUS] is a non-invasive, radiation-free, low-cost tool that is increasingly been used to monitor inflammatory bowel disease [IBD]. However, IUS remains under-utilized in many settings. This is particularly true for ulcerative colitis [UC], a disease defined by distal colonic involvement, and thus amenable to direct visualization through either sigmoidoscopy or colonoscopy. UC is routinely described as a disease 'limited to the mucosa', although evidence from cross-sectional imaging demonstrates sub-mucosal involvement in at least moderate cases and in more severe cases, extra-mural disease manifestations are often present, such as reactive mesenteric inflammation and lymphadenopathy. This challenges the notion of a disease limited to a single layer in the colon, and repeatable transmural imaging may better reflect disease burden. Ideally, an accurate, non-invasive tool to evaluate the colon easily and repeatedly, used to depict the extent and severity of disease, would simply and easily inform clinical decisions.
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