#23 Intestinal ultrasound (IUS) in IBD - with Dr Gauraang Bhatnagar and Dr William Blad

In episode 23 of Wrestling the Octopus IBD, Nigel and I welcome consultant radiologist, Dr Gauraang Bhatnagar (Frimley Health NHS Foundation Trust) and consultant gastroenterologist, Dr Will Blad (Barts Health Foundation Trust) to our podcast to discuss intestinal ultrasound (IUS) in inflammatory bowel disease.

🩺 Key Discussion Points

1. What is Intestinal Ultrasound (IUS)?

• Non-invasive imaging technique for assessing Crohn's disease and ulcerative colitis
• Performed by gastroenterologists and radiologists.
• Increasingly used in clinics and flare settings to reduce reliance on MRI and colonoscopy.

2. Role Compared to Colonoscopy

• Colonoscopy remains essential for diagnosis and cancer surveillance.
• IUS reduces need for repeated colonoscopies and MRIs.
• Best care comes from combining modalities -  no single test is perfect.

3. Preparation

• Minimal prep required (short fast, full bladder).
• Often performed without prep in clinic or inpatient settings.
• Patient-friendly compared to colonoscopy bowel prep.

4. What Does IUS Show?

• Focuses on bowel wall thickness, middle and outer layers and complications outside the bowel.
• Observes bowel in its natural state, unlike MRI or colonoscopy.
• Can detect strictures, narrowings, and motility issues.
• Patients can see images live, strengthening engagement and understanding.

5. Detecting Complex Pathology

• Depth limitations: deeper structures harder to visualize.
• Best practice: baseline imaging with MRI/colonoscopy plus IUS.
• IUS then used for repeat monitoring and treatment adjustments.

6. Empowering IBD Patients

• Patients value seeing their scans in real time.
• Builds trust and strengthens shared decision-making.
• Encourages adherence to treatment when improvements are visible.

7. Monitoring Remission & Flares

• IBD is unpredictable; flares can occur despite remission.
• IUS is well tolerated, cheaper, and acceptable for regular monitoring.
• Helps detect subclinical disease activity early.

8. Duration of IUS

• Acute severe colitis: a few minutes.
• Complex Crohn’s disease: 15–20 minutes.
• Typical clinic use: 5–15 minutes depending on complexity.

9. Expanding IUS in the UK

• Vision: IUS available in every IBD service nationwide.
• Current uptake: limited, mostly in London and radiology departments.
• Need for training, shared expertise, and national coordination.

10. Shared Decision-Making

• Patients feel more connected when they see scans.
• Radiologists gain a more clinical role, motivating patients through visible progress.
• Strengthens collaboration between patients and clinicians.

11. Limitations

• Not suitable for all conditions; CT, MRI, or colonoscopy still required in many cases.
• Obesity and deep pelvic loops can reduce image quality.
• Baseline imaging helps determine which modality is best for ongoing monitoring.

12. Equipment & Technology

• Standard ultrasound machines with specialized probes and optimized settings.
• Recent advances allow greater detail, driving wider adoption of bowel ultrasound.

13. Patient Education & Advocacy

• Need for more patient-facing materials on IUS.
• Collaboration with Crohn’s & Colitis UK, IBD UK, and other societies

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