Feature Story | 8-Feb-2024

A new ultrasound technology is revolutionizing IBD care at UNC School of Medicine

University of North Carolina Health Care

CHAPEL HILL, N.C. – For gastroenterologists, getting eyes on the gut traditionally requires timely MRI testing or endoscopy procedures.

Patients grappling with Inflammatory Bowel Disease (IBD) must return multiple times to collect the necessary data for managing their treatment regimen. However, a new wave of technological advancements and streamlined training processes are providing GI specialists the ability to assess treatment efficacy and disease progression within minutes.

Gastroenterologists, including Millie Long, MD, MPH, and Edward Barnes, MD, MPH at the UNC School of Medicine’s Department of Medicine, are undergoing rigorous training to introduce intestinal ultrasound (IUS) to their repertoire of imaging techniques. The UNC School of Medicine is expected to be the first site in the Southeast to offer this cutting-edge management tool.

Introducing Intestinal Ultrasound

Before, physicians relied on stool and blood markers, pediatric growth indicators, and endoscopic signs of bowel healing to help manage IBD. With access to high-resolution images of the bowel, provided by the ultrasound, gastroenterologists can measure the thickness of the bowel as a measure of inflammation in real-time during routine appointments. The non-invasive nature and lack of radiation makes IUS especially valuable for pregnant and pediatric patients.

The longitudinal (left) and cross-section (right) views of the bowel on ultrasound.

This revolutionary technology can display either the longitudinal or cross-section area of the bowel. Starting from the lumen (middle of the intestine), gastroenterologists can meticulously measure each layer, including the submucosa, muscularis propria, deep mucosa, and more, providing a comprehensive evaluation of inflammation and how the bowel is responding to treatment.

In IBD patients with bowel thickness, a specialized Doppler enhances diagnostics. Gastroenterologists can identify blood flow, visualized as blue and red signals on ultrasound, effectively differentiating active inflammation causing the bowel to appear thick from scarring.

Moreover, this advanced imaging technique enables the detection of abscesses, inflammatory fat, and loss of preservation of the bowel wall layer stratification. The IUS can be completed in less than 10 minutes during a routine care visit. Ultrasound is also beginning to emerge as an endpoint in IBD clinical trials. With these insights, gastroenterologists can refine treatment plans and tailor interventions to address specific manifestations of IBD.

The new care model does require clinics to purchase an expensive ultrasounds machine with high quality B-Mode, Doppler effect and two transducers. Training gastroenterologists to use the technology can also be a large financial investment. A generous donation from The Loewenthal Family Fund has supported the implementation of IUS at the UNC School of Medicine.

“The power of philanthropy in medicine is evident by the development of this innovative intestinal ultrasound program,” said Long, professor of medicine in the Division of Gastroenterology and Hepatology. “Gifts such as the one from the Lowenthal Family Fund will change lives for the better and allow UNC to provide cutting edge care to our population of patients living with IBD.”

Insight from Europe

Although this imaging technique is not common practice in the United States, specialists in Europe have been using ultrasound as an imaging modality for patients with IBD for a decade. Through overseas studies patients have expressed the use of IUS helps them learn more about the disease, understand where symptoms come from, and make informed decisions about managing their IBD.

“Some of the medications can have complications or side effects,” said Long. “When you’re showing a patient their inflamed bowel wall on ultrasound while explaining why we need to modify treatment, it helps them make an informed decision.”

The International Bowel Ultrasound Group, based in Europe, has created a certification program for gastroenterologists interested in learning IUS techniques. Comprised of three modules, the training requires three days of workshopping followed by up to four weeks of hands-on training at a certified center. Finally, specialists must demonstrate the ability to use IUS at an advanced workshop and through testing.

Putting the Probe in Program

Barnes (bottom left), Neil D. Shah, MD, (middle left) and Long (middle right) with UNC GI fellows.

The University of Chicago, Mount Sinai Health System and Houston Methodist Hospital are currently the three certified sites actively using this technology in the United States. Long and Barnes are set to complete their training in May. Hans Herfarth, MD, PhD, director of the UNC Multidisciplinary Inflammatory Bowel Diseases (IBD) Center, is expected to be certified in 2025.

The UNC Multidisciplinary IBD Center stands as one of the largest in the country, with over 3,000 patient visits from across the Southeast every year. Limiting the number of times someone has to return for testing would pave the way to more efficient and personalized care.

Dr. Long envisions IUS training being implemented into the UNC Division of Gastroenterology’s Fellowship Program. These specialists would then be equipped to use IUS in clinic, ultimately shifting the way providers manage treatment for IBD patients.

About UNC School of Medicine

The UNC School of Medicine (SOM) is the state’s largest medical school, graduating more than 180 new physicians each year. It is consistently ranked among the top medical schools in the US, including 5th overall for primary care by US News & World Report, and 6th for research among public universities. More than half of the school’s 1,700 faculty members served as principal investigators on active research awards in 2021. Two UNC SOM faculty members have earned Nobel Prize awards.


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