Intestinal Research

Transabdominal ultrasonography for small-bowel lesions in Crohn’s disease: a prospective comparison with balloon-assisted enteroscopy: Masahiro Takahara, Sakiko Hiraoka, Keiko Takeuchi, Kensuke Takei, Toshihiro Inokuchi, Yuki Aoyama, Shoko Igawa, Mikako Ishiguro, Junki Toyosawa, Yasushi Yamasaki, Hideaki Kinugasa, Hideki Onishi, Motoyuki Otsuka; Received January 10, 2026 Accepted April 26, 2026 Published online July 27, 2026; DOI: https://doi.org/10.5217/ir.2026.00015 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Transabdominal ultrasonography (TUS) is increasingly used to assess small-bowel lesions in Crohn’s disease (CD); however, the diagnostic performance of prospective segment-specific data relative to balloon-assisted enteroscopy (BAE) remains limited.
Methods
In this prospective, single-center study, 94 patients with CD underwent TUS the day before BAE. The diagnostic accuracy of TUS for mucosal inflammation and stenosis was evaluated separately for the terminal ileum and proximal small bowel, using BAE as the reference standard and endoscopic criteria based on the Simple Endoscopic Score for Crohn’s Disease. We performed exploratory analyses of clinical factors associated with TUS detectability, including multivariable logistic regression for inflammatory lesions and exploratory comparisons for stenosis.
Results
For mucosal inflammation, TUS sensitivity and specificity were 69% and 94% in the terminal ileum (accuracy, 90%) and 91% and 82% in the proximal small bowel (accuracy, 84%), respectively. For stenosis, the sensitivity and specificity were 78% and 98% in the terminal ileum (accuracy, 96%) and 63% and 89% in the proximal small bowel (accuracy, 84%), respectively. In exploratory analyses of BAEconfirmed inflammatory lesions, anastomotic involvement, history of bowel resection, and small-bowel resection were associated with TUS detectability in univariate analyses. No independent predictors were identified in the multivariable logistic regression.
Conclusions
Compared to BAE as the reference standard, TUS showed high specificity and segment-dependent sensitivity for detecting small-bowel inflammation and stenosis. These findings support TUS as a complementary, practice-informing, and noninvasive assessment tool, indicating that additional evaluation may be needed when clinical suspicion persists despite negative or equivocal TUS findings.

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IBD

Combined eosinophilic gastroenteritis and ulcerative colitis successfully treated by vedolizumab: a case report: Hironobu Takedomi, Kayoko Fukuda, Suma Inoue, Nanae Tsuruoka, Yasuhisa Sakata, Shigehisa Aoki, Motohiro Esaki; Intest Res 2025;23(1):107-111. Published online August 29, 2024; DOI: https://doi.org/10.5217/ir.2024.00013

A 47-year-old man with over 10 years’ duration of ulcerative colitis treated by 5-aminosalicylic acid and intermittent topical steroids complained of acute epigastric pain. Esophagogastroduodenoscopy revealed diffuse mucosal edema with patchy redness, multiple erosions and nodularity of the stomach. Bioptic examination revealed marked eosinophilic infiltration, confirming the diagnosis of eosinophilic gastroenteritis. Systemic steroid therapy was initiated, whereas his ulcerative colitis and eosinophilia recurred when tapering the steroid. Addition of azathioprine was ineffective, and we subsequently started vedolizumab for eosinophilic gastroenteritis and ulcerative colitis. The medication effectively improved his abdominal symptoms and esophagogastroduodenoscopy and ileocolonoscopy 1 year later revealed endoscopic improvement of both diseases with histologically decreased level of eosinophilic infiltration. Considering that eosinophils also express α4β7 integrins, vedolizumab can be a possible therapeutic candidate for eosinophilic gastroenteritis as well as ulcerative colitis.

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Vedolizumab Induces Remission in Two Cases of Ulcerative Colitis With Upper Gastrointestinal Involvement
Shinya Nakatani, Yuta Yamazaki, Kensuke Higuchi, Yumi Otoyama, Norihiro Suzuki, Kazuo Kikuchi, Takahisa Fujiwara, Atsushi Katagiri, Jyun Ohara, Hitoshi Yoshida
DEN Open.2026;[Epub] CrossRef

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Steroid-refractory extensive enteritis complicated by ulcerative colitis successfully treated with adalimumab: Shinji Okabayashi, Taku Kobayashi, Tomohisa Sujino, Ryo Ozaki, Satoko Umeda, Takahiko Toyonaga, Eiko Saito, Masaru Nakano, Maria Carla Tablante, Shojiroh Morinaga, Toshifumi Hibi; Intest Res 2017;15(4):535-539. Published online October 23, 2017; DOI: https://doi.org/10.5217/ir.2017.15.4.535

Abstract PDF PubReader ePub

Extracolonic involvement of the gastrointestinal tract is extremely uncommon in ulcerative colitis (UC) and rarely found in the upper gastrointestinal tract or in postoperative cases since it typically responds to steroids. Here we report a case of UC complicated by extensive ileal inflammation that was refractory to steroids. A 20-year-old man was diagnosed with UC of typical pancolitis without ileal involvement and started treatment with pH-dependent mesalazine and oral prednisolone. Although his symptoms transiently resolved, the condition flared when the steroid dose was tapered down. Computed tomography revealed marked thickening of the ileal wall, and capsule endoscopy and balloon-assisted enteroscopy found diffuse mucosal inflammation with ulcers in the ileum. On the contrary, the inflammation in the colon and rectum was improving. Since the response to the second steroid course was inadequate, treatment with adalimumab and 6-mercaptopurine was initiated and finally achieved clinical and endoscopic remission. The investigation of small intestinal lesions is necessary in patients with UC whose clinical deterioration cannot be explained by colonic lesions.

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A case of relapsed pan-colonic ulcerative colitis accompanied with gastroduodenal lesions immediately after COVID-19
Katsuya Endo, Tomonori Satoh, Yuki Yoshino, Shiho Kondo, Yoko Kawakami, Daisuke Fukushi, Atsuko Takasu, Takayuki Kogure, Morihisa Hirota, Kennichi Satoh
Clinical Journal of Gastroenterology.2025; 18(3): 399. CrossRef
Clinical Features and Therapeutic Outcomes of Post-colectomy Enteritis with Ulcerative Colitis
Yuki Horio, Motoi Uchino, Kazutoshi Hori, Kurando Kusunoki, Tomohiro Minagawa, Ryuichi Kuwahara, Kozo Kataoka, Naohito Beppu, Masataka Ikeda, Hiroki Ikeuchi
Journal of the Anus, Rectum and Colon.2021; 5(4): 405. CrossRef

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