Intestinal Ultrasound Guided Management in Inflammatory Bowel Disease

This is a single‐center randomized controlled trial conducted at the IBD Clinic, Facultyof Medicine Siriraj Hospital, Mahidol University.Adult patients with inflammatory bowel disease (Crohn's disease or ulcerative colitis)who are undergoing endoscopy for assessment of disease severity are randomized 1:1, usingcomputer‐generated block‐of‐four randomization, to either standard of care plusintestinal ultrasound (IUS) or standard of care alone. Participants are followed for 48weeks.Follow‐up visits are scheduled every 2 months for participants with active disease (Mayoendoscopic score of 2 or higher, or SES‐CD of 3 or higher) and every 4 months forparticipants in remission.In the IUS arm, intestinal ultrasound is performed at every visit by physicians certifiedby the International Bowel Ultrasound Group (IBUS). The physician performing theultrasound is blinded to the blood and stool test results obtained on the same day.Measured parameters include bowel wall thickness (BWT), color Doppler signal, andmesenteric fat hypertrophy.Standard of care in both arms includes clinical disease activity scores (partialMayo/PRO‐2 for ulcerative colitis, or Harvey‐Bradshaw Index/PRO‐2 for Crohn's disease),complete blood count, C‐reactive protein, fecal calprotectin, and colonoscopy asclinically indicated.The primary outcome is the proportion of participants with a change in treatment duringthe 48‐week follow‐up period.