Ultrasound Imaging of the Small Bowel

[ncman]

I just wanted to raise awareness of a newer way of imaging Crohn's, and that is ultrasound.

For general Crohn's disease without too many complications, it's an ideal way as there's no IV contrast, and nothing to drink either. I only had to fast for 6 hours prior to the test (so it's better to book it in the morning if you can...mine wasn't done till 5pm as they were running late!). And there's no prep either. And it's quick too, it only takes around 20 minutes in total.

Is it better than MRI? The consultant radiologist I had basically said it depends on the training of the individual. His seniors had trained him in US, and he now trains his juniors in the same way, so he felt US in his hands could pick up more than MRI. It can be used to diagnose CD too.

So it is dependent on the person, but in experienced hands, yes it is better.

It's not so good for rectal disease, as those tissues are too deep to be seen. So you'd need MRI for that. But you can get a good look at the small and even large bowel.

How hard did he press on my stomach? He was strong, and did press down firmly at my ileum and caecum, but not uncomfortably so. I wasn't tender at the time of the exam, but even if I had been, I think it would have been tolerable.

In the UK, there's currently a trial being conducted, the METRIC trial (Magnetic resonance Enterography or ulTRasound In Crohn's disease) where patients on the biologics are being monitored this way.

I hope this helps someone. If your doctor suggests an MRI, don't be afraid to ask for an ultrasound if you think it'd be better for you!

 

[Becks35]

Hey! I'm having an ultrasound this afternoon and have struggled to find people's previous experiences of them so thanks for the post how was it with finding anything/diagnosis? I have heard mainly bad things and hope this isn't the case

 

[ncman]

Hi,

What do you mean you've heard bad things?

Was your ultrasound experience similar to mine?

I'd already been diagnosed, but I think it's a much better monitoring tool than MRI, but it can be used as a diagnostic tool too.

Between the US to image the gut and the Doppler ultrasonography to reveal blood flow, I think it can pick up most issues.

(I noticed you're based in Leicester and wondered who your consultant was - I'm currently seen in London and I wasn't aware of any Midlands based GIs using US.)

 

[cassimw]

The first test my 15 year old had when she complained of stomach pain was an ultrasound. She had an amazing ultrasound doctor, who actually saw both Crohn's and a fistula. She consulted with my daughter's pediatrician and they sent her for an immediate CT scan that same day. The following day we saw a GI, who gave us the diagnosis (various bloodwork/stool tests/colonoscopy & endoscopy and an MRE followed in the next few weeks to confirm the diagnosis and assess the severity of the disease). My daughter was just diagnosed 3 months ago.

Recently, my daughter was experiencing more pain. The GI sent her for another ultrasound to make sure there were no new developments (strictures, blockages, more fistulas, etc.). There were none. We ended up having the same ultrasound doctor. She was quick to point out that ultrasound is not ideal for seeing what's going on with Crohn's. She said she was lucky to see it in the first ultrasound. That's what our GI told us too, but it's only been 3 months since she started Remicade & 1 month on 6-MP and the GI didn't want to do a repeat MRE just yet, because, as you know, it's more invasive and you have to fast and then drink that nasty contrast. Plus it's much more expensive.

I just wanted to chime in what our experience and what I know. Best to all of you!

(ps - so lucky you live in the UK! I've always wanted to visit!)