Revolutionizing Pediatric IBD Care With IUS
Today, pediatric inflammatory bowel disease (IBD) is growing in frequency, with 100 to 200 out of 100,000 American children experiencing the condition, according to research published in JAMA Pediatrics. Visualizing the presence and effects of IBD is essential for proper diagnosis and management. In June 2024, the IBD Center at Nicklaus Children’s Hospital became the fourth children’s hospital in America with an intestinal ultrasound (IUS) program.
“Our IUS ultrasound program has transformed our care for patients with IBD,” says Lina Maria Felipez, MD, pediatric gastroenterologist, Associate Medical Director of the Inflammatory Bowel Disease Center, Associate Program Director of the Pediatric Gastroenterology, Hepatology and Nutrition Fellowship Program, associate professor at Florida International University (FIU) and director of IBD research at Nicklaus Children's Hospital. “This imaging procedure takes place in the office with no prep and — most importantly for our pediatric patients — no downtime.”
IUS allows children to continue eating normally, significantly reducing pre-exam fussiness and discomfort, promoting instant improvement in the patient experience. Benefits of IUS, however, stretch beyond the initial lack of discomfort experienced by young patients.
Revolutionizing the Diagnostic Process
Traditional diagnosis of Crohn’s, colitis and other IBD is a painstaking process requiring multiple tests and time. Detecting any type of IBD in this manner requires the following:
Though effective at pinpointing the presence and type of IBD, this process can drag on for a prolonged period, as clinicians rely on outside imaging specialists, who may have a backlog of cases, pushing imaging back several months. IUS empowers clinicians to take meaningful strides toward a diagnosis during a patient’s initial consultation.
With IUS, clinicians may move toward a diagnosis quickly. If the clinician suspects IBD, an immediate IUS helps seek out any thickened or inflamed section of the bowel. A biopsy then confirms the findings, allowing treatment to begin much sooner.
“The time to diagnosis and treatment is greatly condensed with IUS,” Dr. Felipez says. “We do the scope and get a biopsy.”
The Role of IUS in Ongoing Management
IUS also improves the maintenance of children with IBD. Colonoscopy and endoscopy were once required standards of care for evaluating disease progression and medical therapy's efficacy. Even when in remission, children underwent these exams as frequently as every six months.
Bypassing these tests in favor of IUS decreases sedation and preparation, reduces radiation exposure and further improves the maintenance experience.
“IBD is a long journey, and we see children who are diagnosed at very young ages,” says Luis Caicedo Oquiendo, MD, pediatric gastroenterologist, Director of the Pediatric Gastroenterology, Hepatology and Nutrition Fellowship Program and Medical Director of the Fecal Care Program at Nicklaus Children’s and associate professor at FIU. “We know that radiation increases the risk of leukemia and brain tumors. Eliminating radiation is a significant benefit to using this technique.”
During maintenance appointments, clinicians use IUS to quickly determine whether a patient is in remission or has an active disease and gauge how well current therapy is working. Treatment changes can then be made on the spot to improve outcomes, and follow-up screening a few weeks later can show whether the treatment changes have the desired effect.
As an added benefit, IUS increases patient and family understanding of the disease process.
“Because IUS is a bedside tool, we can show patients their bowel in real-time,” Dr. Felipez says. “This allows them to see improvement in their IBD management, which is very encouraging.”
Working Within Limitations
Though IUS reduces the need for more invasive testing, it does not eliminate the need for colonoscopy and endoscopy. Like all imaging tools, IUS has inherent limitations. Primarily, IUS is not helpful in imaging the upper bowel and rectum. It is also ineffective in imaging children with obesity and exceptionally young children and others who have difficulty sitting still. Out-of-the-box approaches, such as allowing children with autism to use a tablet during screening, allow clinicians to capture clear IUS images on children who may otherwise be uncooperative.
Working within these limitations, Nicklaus Children’s clinicians performed approximately 250 IUS procedures on children from June to October 2024. Half of these were performed in a maintenance capacity, prescribed to determine the ongoing status of IBD-diagnosed patients.
The remaining screenings aided in the following:
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Determining the root cause of children experiencing failure to thrive
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Identifying the cause of severe abdominal pain
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Ruling out IBD in patients with IBD-like symptoms
In appropriate applications, IUS images have such clarity that the patient does not require additional diagnostic imaging, such as endoscopy or colonoscopy. For children diagnosed with IBD, differentiating between an IBD flare-up and stress- or irritable bowel syndrome-induced stomach pain is a streamlined process with powerful results.
“The first time I saw IUS in action, it gave me goosebumps,” Dr. Caicedo says. “It allows us to see patients differently. Some call this the stethoscope of the 21st century, and I agree. It’s a game changer.”
Email our physician liaison to refer a pediatric patient to the IBD Center at Nicklaus Children’s, Florida’s only provider of intestinal ultrasound.