Download PDF
Open Access
CC BY 4.0 · Ultraschall Med
DOI: 10.1055/a-2789-6390
Original Article

Submucosal bowel wall layer thickness predicts endoscopic activity in Crohn's disease

Die Dicke der submukösen Darmwandschicht sagt die endoskopische Aktivität bei Morbus Crohn voraus

Authors

  • Kim Nylund

    1   Department of Medicine, Haukeland University Hospital, Bergen, Norway (Ringgold ID: RIN60498)
    2   Department of Clinical Medicine, University of Bergen, Bergen, Norway (Ringgold ID: RIN1658)

  • Ole Kristian Horpestad

    3   Department of Medicine, Nordlands Hospital Trust, Bodø, Norway (Ringgold ID: RIN60481)

  • Fredrik Sævik 

    4   Department of Medicine, Sørlandet Hospital, Arendal, Norway

  • Odd Helge Gilja

    5   National Center of Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway (Ringgold ID: RIN60498)
    2   Department of Clinical Medicine, University of Bergen, Bergen, Norway (Ringgold ID: RIN1658)
Further Information
Also available at
 PDF Download

Purpose Gastrointestinal ultrasound is a well-established method for diagnosing and following Crohn’s disease (CD). The aim of this study was to investigate whether wall layer data measured on gastrointestinal ultrasound could predict endoscopic activity in CD. Materials and methods 64 CD patients underwent a gastrointestinal ultrasound examination and endoscopy ± 2 weeks apart in a single-centre prospective study. Bowel wall thickness and the thickness of individual wall layers corresponding to mucosa, submucosa and the proper muscle wall were measured and compared with simple endoscopic score of Crohn’s disease (SES-CD) in the worst affected bowel segment where SES-CD >2 was defined as activity. Results There was increased absolute thickness of mucosa (1.8 versus 1.1mm, p =0.001), submucosa (2.8 versus 1.2mm, p <0.001) and proper muscle (1.6 versus 1.1mm, p =0.006) in patients with endoscopic activity. After a ROC analysis Youden’s index suggested a 1.8 mm cut off for submucosal thickness and disease activity giving 90% sensitivity, 78.3% specificity and 84.9% accuracy. In contrast, a bowel wall thickness of 3 mm had a 97.3 % sensitivity, 52.0 % specificity and 79.0% accuracy. The submucosa was also relatively thicker (0.45 versus 0.36, p=0.008) while the proper muscle was relatively thinner (0.25 versus 0.34, p=0.001) in endoscopic activity. Conclusion Patients with Crohn’s disease and endoscopic activity had increased thickness of all bowel wall layers in affected areas. Measurements of the submucosa may be used to assess disease activity with similar results as bowel wall thickness.



Publication History

Received: 27 March 2025

Accepted after revision: 17 November 2025

Accepted Manuscript online:
15 January 2026

© . The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany