Intestinal Ultrasound for Diagnosis and Management of Inflammatory Bowel Disease

This episode of PHM from Pittsburgh marks the podcast's 10-year anniversary and features Dr. Michael Dollinger, director of the Pediatric Inflammatory Bowel Disease Program at NYU Grossman School of Medicine, discussing the transformative role of intestinal ultrasound in diagnosing and managing inflammatory bowel disease (IBD) in children. Traditionally, IBD diagnosis relied on colonoscopy with biopsy and radiation-based imaging like CT or MRE, both of which are invasive, time-consuming, and expose patients to radiation or sedation. Dr. Dollinger highlights that intestinal ultrasound—non-invasive, radiation-free, and capable of high-resolution imaging of all four layers of the bowel wall—has emerged as a superior tool for detecting transmural inflammation, which is central to both Crohn’s disease and ulcerative colitis. He challenges long-standing medical teaching that ulcerative colitis is limited to the mucosa, citing ultrasound evidence that it is, in fact, transmural and driven by submucosal inflammation. The episode emphasizes how ultrasound enables real-time diagnosis, faster clinical decision-making, and early monitoring of treatment response, with studies showing that a 20–25% reduction in bowel wall thickness within 48–72 hours predicts long-term remission with 100% accuracy. Despite strong evidence, adoption remains slow due to institutional inertia, lack of training, and outdated guidelines. Dr. Dollinger founded IUSCAN (Intestinal Ultrasound Group of the United States and Canada), a nonprofit organization offering free, scalable training for gastroenterologists and trainees to accelerate the integration of this modality into clinical practice. The host concludes that ultrasound is poised to become the new standard of care, with a projected timeline of six years for widespread adoption in pediatric IBD diagnosis.