Tuğçe Eşkazan, Gökçe Ceylan, Subhana Alasgarlı, Atilla Akpınar, Okan Katı, Oğuz K. Bakkaloğlu, Yusuf Z. Erzin, Aykut F. Çelik, Ali İbrahim Hatemi
Cerrahpaşa Medical Journal - 2026;50(1):1-5
Objective: This study aimed to evaluate the intestinal ultrasound (IUS) findings in Crohn's disease (CD) patients who achieved endoscopic remission (ER) and to compare the clinical and treatment-related features between patients with and without ultrasound remission (UR). Methods: Endoscopic remission was defined as a Simple Endoscopic Score for CD <=2 in each intestinal segment. Bowel wall thickness (BWT), color Doppler signal (CDS), bowel wall stratification, and mesenteric fat inflammation were assessed. International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) and Bowel Ultrasound Score (BUSS) scores were calculated. Ultrasound remission was defined as IBUS-SAS score below 25 or as BUSS score below 3.52 in each segment. Transmural activity was defined as the absence of ultrasound remission, i.e., the presence of at least 2 intestinal segment exceeding the aforementioned thresholds. Results: Among 24 patients in ER, transmural activity was detected in 7 patients (29.2%) using IBUS-SAS, while only 1 patient (4.2%) was positive according to BUSS. When BWT alone was used as the marker of transmural activity , 4 patients (16.7%) were classified as not achieving TR, including 1 patient with an IBUS-SAS score below the activity threshold. When transmural activity was defined as the combination of BWT >=3 mm and CDS >=1, only 1 patient (4.1%) met the criteria. Perianal disease was observed more frequently in patients without UR compared to those achieving UR (42.9% vs. 5.9%), although this difference did not reach statistical significance. Similarly , the rate of biologic treatment and the duration of therapy were higher among patients without UR again without attaining statistical significance. Conclusion: Nearly one-third of CD patients in ER may have residual transmural activity detectable by IUS. Persistent inflammatory burden, such as perianal disease, may delay transmural healing despite mucosal remission.
