What question did this study set out to answer?

The study aims to determine early intestinal ultrasound parameters that predict steroid non-response in patients with acute severe ulcerative colitis.

January 23, 2026Journal of Crohn s and Colitis0 citations

View Full Paper

P0421INSPIRE: INtestinal ultraSound Parameters for Identifying steroid non-response in patients with acute seveRE ulcerative colitis

DSDeloshaan Subhaharan AHA Haig WMW Mohsen

Key Points

The study aims to determine early intestinal ultrasound parameters that predict steroid non-response in patients with acute severe ulcerative colitis.
Prospective study design
Involvement of adults with acute severe ulcerative colitis
Intestinal ultrasound performed on admission and 48±24 hours later
Assessment of bowel wall thickness and submucosal thickness
Logistic regression and ROC analyses to identify predictive thresholds
50% of patients required medical rescue therapy due to steroid non-response
Higher bowel wall thickness at admission (5.6 vs 4.4mm) predicted non-response
Intestinal ultrasound parameters outperformed conventional clinical indices for predicting steroid non-response
Specific thresholds identified with high specificity and positive predictive value (PPV)
Milan Ultrasound Criteria also demonstrated strong predictive value

Abstract

Abstract Background Intestinal ultrasound (IUS) is increasingly used for non-invasive assessment of ulcerative colitis (UC). Its role in predicting corticosteroid response in acute severe UC (ASUC) is not well established. The INSPIRE study aimed to identify early IUS parameters associated with steroid non-response in ASUC. Methods In this prospective study, adults admitted with ASUC (per Truelove and Witts criteria) underwent IUS on admission (T1) and 48±24 hours later (T2). Parameters assessed included bowel wall thickness (BWT), submucosal thickness (SMT), and Milan Ultrasound Criteria (MUC). Steroid non-response (SNR) was defined as the need for medical rescue therapy (MRT). Logistic regression and ROC analyses identified predictive thresholds. Results Twenty patients were included, median age 33 years (IQR 25.5-46), 50% were female. All had left-sided or pancolitis, and in 90% the sigmoid colon was the most severely affected segment. Ten (50%) patients required MRT. On univariable analysis, T1BWT, T1SMT, T2BWT and T2SMT were predictors of SNT. Doppler, stratification and haustrations were not predictive. Non-responders had greater T1BWT (5.6 vs 4.4mm, p0.001) and T2BWT (4.5 vs 2.9mm, p0.001). T1BWT ≥5.6mm identified SNR (specificity 100%, PPV 100%, OR 44.9, 95% CI 6.6-305, p0.001). Patients with T1BWT 4.7mm were highly likely to respond to steroids (PPV 100%). T1BWT outperformed admission UCEIS, CRP, albumin, and the ADMIT-ASC score for predicting SNR. T2BWT ≥4.4mm identified SNR (specificity 100%, PPV 100%, AUROC 0.80) and outperformed the Oxford Index (AUROC 0.60). T1MUC ≥8.6 (AUROC 0.85) and T2MUC ≥6.5 identified SNR (AUROC 0.95). Conclusion T1BWT ≥5.6mm and T2BWT ≥4.4mm identify steroid non-response in ASUC and outperform conventional clinical indices. IUS provides a practical bedside tool for early risk stratification and therapeutic decision-making. Conflict of interest: Dr. Subhaharan, Deloshaan: No conflict of interest Haig, Adam: Nil Mohsen, Waled: No conflict of interest Kakkadasam Ramaswamy, Pradeep: None

Ask AI

Helpful

Bookmark

View Full Paper

Ask AI

Helpful

Bookmark

View Full Paper

P0421INSPIRE: INtestinal ultraSound Parameters for Identifying steroid non-response in patients with acute seveRE ulcerative colitis

Key Points

Abstract

Cite This Study

Also Consider

Also Consider