Use of Intestinal Ultrasound and Other Imaging Tests in Ulcerative Colitis and Crohn’s Disease: Insights From a German Physician Survey

Irina Blumenstein,¹ Xiaoxiao Alice Lu,² Ursula Kleine-Vossbeck,³ Shashi Adsul,⁴ Yichen Zhang,² Meshal Imran,² Yan Wang,⁵ Aolin Wang,⁶ Rouven Hecht,³ Lukas Scharfenberger,³ Julian Pohlan,³ Ivana Bravata,³ Darren Piscitelli,⁴ Jessica Smith,⁷ Anyu Zhu,⁷ Claudia Ott⁸

Key Takeaways

Background and Objectives

• Imaging tests play a critical role in the management of ulcerative colitis (UC) and Crohn’s disease (CD), including diagnosis, assessment, monitoring, and complication management.¹
• Among the available imaging tests for UC and CD, Intestinal ultrasound is evolving as an important option given it is a non-invasive option that can be performed directly by gastroenterologists. Moreover, it offers reasonably high sensitivity and specificity, is patient-friendly, cost-effective, and produces real-time results.^2,3
• This study aimed to assess physicians’ use of imaging tests and reasons for intestinal ultrasound use in Germany by practice setting and perceived importance of transmural healing as a long-term treatment goal for moderate-to-severe UC or CD.

Methods

Study design

• Cross-sectional, web-based, invitation only, German-language survey of gastroenterologists practicing in Germany (September–October 2025), invited from a large, national physician directory.
• The questionnaire underwent review by experts with domain knowledge, internal stress testing and consistency checks, and pretesting for clarity and usability; it was programmed to require responses for all applicable items, resulting in no item-level missing data, and the final instrument and analysis plan were finalized prior to data collection

Sample criteria

Eligibility criteria for licensed physicians included:

• Primary specialty in gastroenterology
• Practiced in Germany
• Prescribed an advanced treatment (i.e., biologic therapy, Janus kinase inhibitor, sphingosine 1-phosphate receptor modulator) to ≥1 patient with moderate-to-severe UC or CD in the past 12 months, excluding patients enrolled in interventional clinical trials.

Study measures

• Data on physician characteristics, imaging test use, and reasons for intestinal ultrasound use were collected.
• Physicians were also asked to rank their long-term (i.e., ≥12 months) treatment goals, using a 5-point Likert-type importance rating from most important to least important.

Statistical analysis

• Study measures were summarized overall and stratified by practice setting and physicians’ perceived importance of transmural healing (based on intestinal ultrasound, magnetic resonance imaging, or computed tomography) as most important vs. less-than-most important.
• Means and standard deviations (SDs) were used for continuous variables and counts and proportions for binary variables.

Results

A total of 76 gastroenterologists participated in the survey (mean [SD] age 52.9 [8.1] years; mean [SD] practice duration 21.8 [6.8] years).

Table 1: Characteristics of participating physicians

Abbreviations: N = number; SD = standard deviation; UC = ulcerative colitis; CD = Crohn’s disease.
Notes: ¹Multiple responses permitted. A medical care center was defined as a regional center or health center, composing several physicians, possibly from different specialties.

Physicians who viewed transmural healing as a most important long-term goal, compared to those viewing it as less-than-most important

• More often reported any intestinal ultrasound use (UC: 93.3% vs 82.0%; CD: 94.7% vs 87.7%).
• Were more likely to use intestinal ultrasound for treatment-response monitoring in UC (85.7% vs 80.0%) or for diagnosis in CD (72.2% vs 52.0%).

Table 2: Commonly used imaging tests and reasons for intestinal ultrasound use by perceived importance of transmural healing as a long-term treatment goal for moderate-to-severe UC and CD

Abbreviations: UC = ulcerative colitis; CD = Crohn’s disease; N = number.

Among the overall sample:

• Most physicians reported using colonoscopy and intestinal ultrasound for both UC (98.7% and 84.2%, respectively) and CD (96.1% and 89.5%), with esophagogastroduodenoscopy also commonly used for CD (90.8%).
• Intestinal ultrasound was primarily used to monitor disease activity and treatment response for both UC (95.3% and 81.2%) and CD (91.2% and 86.8%).

Figure 1: A. Physician use of imaging tests for moderate-to-severe UC and CD in the past 12 months. B. Reasons for use of intestinal ultrasound in clinical practice for moderate-to-severe UC and CD.

Abbreviations: UC = ulcerative colitis; CD = Crohn’s disease.

Across practice setting:

• Most physicians used colonoscopy (94.1–100.0% for both UC and CD) and intestinal ultrasound (64.7–85.0% for UC; 82.4–90.3% for CD), with higher intestinal ultrasound use in private practices and hospitals.

Figure 2: A. Physician use of top 3 imaging tests for moderate-to-severe UC in the past 12 months by practice setting. B. Physician use of top 3 imaging tests for moderate-to-severe CD in the past 12 months by practice setting.

Abbreviations: UC = ulcerative colitis; CD = Crohn’s disease.

Across practice setting:

• Use of intestinal ultrasound for disease-activity monitoring was more common in private practices and hospitals than medical care centers (UC: 100.0% vs 81.8%; CD: 93.3–100.0% vs 71.4%).
• Intestinal ultrasound use for surveillance after surgery was more frequent in non-university hospitals than other settings (UC: 56.2% vs 34.6–46.7%; CD: 75.0% vs 46.4–64.3%).

Figure 3: A. Reasons for use of intestinal ultrasound in clinical practice for moderate-to-severe UC by practice setting. B. Reasons for use of intestinal ultrasound in clinical practice for moderate-to-severe CD by practice setting.

Abbreviations: UC = ulcerative colitis; CD = Crohn’s disease.

PRESENTED AT

21^st Congress of ECCO, February 18–21, 2026, Stockholm, Sweden.

REFERENCES

1. Kilcoyne A. Inflammatory bowel disease imaging: Current practice and future directions. World Journal of Gastroenterology. 2016;22(3):917. doi:10.3748/wjg.v22.i3.917
2. Hoffmann JC, Ungewitter T. Role of Intestinal Ultrasound for IBD Care: A Practical Approach. Diagnostics. 2024;14(15):1639. doi:10.3390/diagnostics14151639
3. Krugliak Cleveland N, St-Pierre J, Kellar A, Rubin DT. Clinical Application of Intestinal Ultrasound in Inflammatory Bowel Disease. Current Gastroenterology Reports. 2024;26(2):31-40. doi:10.1007/s11894-024-00915-x.

¹Fachärztin für Innere Medizin, Gastroenterologie, Universitätsmedizin Frankfurt, Medizinische Klinik 1, Leiterin der CED Hochschulambulanz und der CED Studienambulanz, Germany; ²Global Real World Evidence GCDS GCSO, Johnson & Johnson, Raritan, NJ, USA; ³Janssen-Cilag GmbH, Neuss, Germany; ⁴Global Medical Affairs GCSO, Johnson & Johnson, Horsham, PA, USA; ⁵Analysis Group, Inc., Los Angeles, CA, USA; ⁶Analysis Group, Inc., New York, NY, USA; ⁷Analysis Group, Inc., Boston, MA, USA; 8Innere Medizin Schwerpunkt CED, Gastroenterologie, Facharztzentrum Regensburg, Germany