Non-Invasive Monitoring Bowel Ultrasound in Paediatric IBD (NIMBUS)
Research type
Research Study
Full title
To examine the feasibility of Non-invasive Monitoring with Bowel Ultrasound in Paediatric Inflammatory bowel disease and correlation with inflammatory markers, disease activity scores and as a predictor of changes in treatment (NIMBUS Study)
IRAS ID
321870
Contact name
Martin Edwards
Contact email
Sponsor organisation
Cardiff and Vale University Health Board
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
Research Summary
Rates of inflammatory bowel disease (IBD) are rapidly increasing in children and national guidance recommends close monitoring of gut inflammation; to control symptoms and prevent complications. Current strategies involve endoscopy and colonoscopy and/or MRI scans. These tests are expensive, often require general anaesthetics, and have long waiting lists. Often "bowel prep" with laxatives is needed, which can be distressing for the child and, along with the need for hospital admission, can lead to missed school and disruption.
Studies in gastroenterology are exploring ultrasound scans for monitoring gut inflammation. Ultrasound is cheap, quick, accurate, and can be done routinely. It is used in adult patients with IBD, however little work has been done in children, including how scans relate to existing methods of monitoring (i.e. blood and stool samples) and if scans might predict treatment course.
To examine this in this population we aim to perform 50 ultrasound studies in children with IBD either when attending the Noah's Ark Children's Hospital for Wales for routine appointments (clinics, infusions of medicines, endoscopy) or when admitted with flare of their disease. The targeted ultrasound scan results will be interpreted alongside the current standard of care, including blood and stool results, taken as part of routine clinical care. We will review the clinical notes at twelve months after scan. Each patient will undergo one bowel ultrasound scan, lasting around fifteen minutes. The clinical team will not be made aware of the results of these scans, unless the trained consultant radiologist performing that scan deems that there is a clinical need to inform the gastroenterology team to ensure patient safety.
50 children with a diagnosis of IBD would be eligible for this study. Patients without IBD, who have undergone bowel resection or those part of families unable to give informed consent will be excluded.
Summary of Results
Inflammatory Bowel Disease (IBD), including Crohn's disease and ulcerative colitis, is becoming more common in children. Doctors aim to monitor and treat this condition effectively to prevent long-term damage, but current tools like endoscopy are invasive and not ideal for frequent use in young patients. This study explored whether bowel ultrasound (BUS), a safe and painless scan, could be a useful alternative for monitoring IBD in children.
The study involved 40 children aged 2 to 18, most of whom had ulcerative colitis. Each child had a single bowel ultrasound performed by an experienced paediatric radiologist. The research team looked at whether key ultrasound features could be clearly seen and whether these features matched with other known indicators of inflammation, like faecal calprotectin (a stool test) and blood markers.
BUS was found to be feasible, with 96.5% of scan parameters successfully measured. Only 10% of scans were poor quality, usually due to body composition or gas in the bowel. In children with ulcerative colitis, two ultrasound features-bowel wall thickness and loss of normal patterning-were linked to higher faecal calprotectin levels, which suggests these features may reflect active inflammation. However, this link was not seen in children with Crohn's disease and the ultrasound findings didn't predict treatment changes or future disease behaviour during the short follow-up period.
Overall, the study showed that bowel ultrasound is a promising, child-friendly method for monitoring IBD-especially ulcerative colitis-in children. However, challenges remain, including image quality in some patients and a lack of correlation in Crohn's disease. More research involving larger numbers, multiple scan points, and comparisons with gold-standard tests like endoscopy is needed to better understand how useful BUS could be in routine care for young patients with IBD.
REC name
Wales REC 3
REC reference
23/WA/0028
Date of REC Opinion
24 Mar 2023
REC opinion
Further Information Favourable Opinion