Ruben Colman, MD, PhD: Director of Intestinal Ultrasound at Stanford University

Ruben Colman, MD, PhD

Ruben Colman, MD, PhD, Director of Intestinal Ultrasound at Stanford Medicine

Prioritizing personalized care for children and adolescents with inflammatory bowel diseases (IBD) is critical to achieve early disease control and alleviate the long-term risks of IBD. A promising tool, a point-of-care intestinal ultrasound (IUS), offers a transformative approach that allows real-time, non-invasive images of disease activity directly in the clinic.

Perseus Patel, MD, Clinical Assistant Professor at Stanford Medicine Children’s Health Center for IBD

Historically, IBD diagnosis and treatment have relied on symptoms, blood and stool testing, colonoscopies, and cross-sectional imaging such as MRIs—all of which have drawbacks.

Symptoms and blood tests often do not correlate with mucosal inflammation, while blood tests are invasive, and stool tests are challenging to collect. For conventional cross-sectional imaging, the patient must drink a significant amount of oral contrast before the procedure. Children may find it difficult and anxiety-provoking to lie still in a scanner for a prolonged period, and CT scans expose children to radiation.

While a colonoscopy remains the gold standard to monitor intestinal inflammation, frequent colonoscopies are infeasible in children, owing to their invasive nature, extensive bowel preparation, and anesthesia exposure.

All these tests take time to yield results, delaying the next steps in disease management.

Understanding point-of-care intestinal ultrasound

Contrary to the traditional approaches of monitoring IBD, IUS is a non-invasive abdominal exam that can be performed during routine clinic visits. The exam provides high-level and detailed cross-sectional images of the bowel, allowing clinicians to assess inflammation in the gastrointestinal tract in real time.

The ultrasound exam typically takes 15-20 minutes. A warm gel is applied to the patient’s abdomen, and the ultrasound transducer is gently moved to assess the bowel. This method requires no fasting, preparation, or anesthesia, and exposes the patient to no radiation.

IUS is currently the only real-time, objective tool available for assessing intestinal inflammation in routine clinical care, eliminating delays associated with laboratory tests, stool tests, and traditional cross-sectional imaging. Stanford Medicine Children’s Health is among the first in the nation to provide this service to children as part of its routine IBD care.

Benefits of point-of-care intestinal ultrasound in pediatric IBD

Incorporating IUS into routine care is transforming the management of pediatric IBD. Its real-time imaging allows clinicians to visualize bowel inflammation during a clinic visit, enabling immediate and tailored treatment decisions.

During these visits, patients and families can speak with their care team about managing their disease while viewing the same images and verifying ongoing inflammation on a shared screen. While it does not replace all colonoscopies or traditional imaging tests, it potentially reduces the need for repeat invasive procedures by offering regular, real-time transmural monitoring of treatment response.

 demonstrated that normal bowel wall thickness in pediatric patients with IBD likely differs from adults.

 To further the study of the unique features of pediatric-specific IUS, Stanford Medicine Children’s Health’s Center for IBD and Celiac Disease Intestinal Ultrasound Program instituted a prospective Intestinal Ultrasound Registry to further characterize unique pediatric ultrasound features.

Research from the Stanford Medicine Children’s Health’s Center for IBD and Celiac Disease Intestinal Ultrasound Registry shows that incorporating intestinal ultrasound into a patient’s IBD clinic visit is superior in detecting inflammation compared to routinely used clinical disease activity indices.

 A personalized approach that integrates IUS data with symptoms discussed during a clinic visit may lead to immediate actionable management decisions that ultimately decrease the time to remission.

Integrating IUS into national learning health systems as a routine part of care is essential to further research, improve access, and optimize outcomes for all IBD patients. As such, Stanford Medicine Children’s Health has partnered with other national leaders in pediatric IUS to spearhead efforts to standardize the use of IUS across pediatric IBD centers.

To address the large gap in how many (pediatric) gastroenterologists are currently trained in point-of-care intestinal ultrasound in the United States, Stanford Medicine Children’s Health was at the forefront in seeking accreditation to train both pediatric and adult gastroenterologists in ultrasound through the International Bowel UltraSound (IBUS) group.

A deeper understanding of the utility of IUS as a monitoring tool for transmural disease outcomes may also facilitate access to novel medications, as clinical trials for children still often require multiple colonoscopies. New evidence highlights IUS’s ability to predict disease progression, and early ultrasound changes can indicate a child’s response to therapy.

As symptoms sometimes fail to correlate with inflammation, intestinal ultrasound could offer a proactive approach, allowing clinicians to detect and treat inflammation before symptoms emerge. This powerful tool can help optimize treatment plans, reduce the need for invasive procedures, and improve patients’ quality of life through faster, more targeted care decisions.

Kellar A, Chavannes M, Huynh HQ, et al. Defining normal bowel wall thickness in children with inflammatory bowel disease in deep remission: A multicenter study on behalf of the pediatric committee of the International Bowel Ultrasound Group (IBUS). 

. Published online April 29, 2025. doi:10.1002/jpn3.70049

Patel PV, Zuniga DJ, Goyal A, Bensen R, Bass DM, Moses J, Rosen MJ, Colman RJ. Bowel Wall Thickness and Hyperemia on Routine Clinical Care Intestinal Ultrasounds Are Associated with Clinical and Biochemical Disease Activity in Children with Inflammatory Bowel Disease. Presented at Digestive Diseases Week 2025, San Diego, California

Articles

Personalized care for pediatric IBD is crucial for early disease control and reducing long-term risks. Point-of-care intestinal ultrasound (IUS) offers a non-invasive, real-time imaging solution, overcoming limitations of traditional methods like colonoscopies and MRIs. IUS facilitates immediate treatment decisions by providing detailed images during clinic visits, potentially reducing the need for invasive procedures. Stanford Medicine Children’s Health is pioneering IUS integration, enhancing pediatric IBD management. National efforts aim to standardize IUS use and training, improving access and outcomes for IBD patients through proactive, personalized care.

Point-of-care intestinal ultrasound offers real-time, noninvasive monitoring for pediatric IBD, enabling faster, personalized treatment decisions in routine care.