Sound of Success: Intestinal Ultrasound in the Management of Refractory Stricturing Crohn's Disease

Lindsay M Clarke; Sanchit Gupta; Harland S Winter; Daniel P Ryan; Matthew J Hamilton; Rachel W Winter

doi:10.1007/s10620-025-09172-y

Sound of Success: Intestinal Ultrasound in the Management of Refractory Stricturing Crohn's Disease

Dig Dis Sci. 2025 Jun 25. doi: 10.1007/s10620-025-09172-y. Online ahead of print.

Authors

Lindsay M Clarke^{1

2}, Sanchit Gupta^{1

2}, Harland S Winter³, Daniel P Ryan⁴, Matthew J Hamilton^{1

2}, Rachel W Winter^{5

6}

Affiliations

¹ Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
² Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
³ Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, Department of Pediatrics, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA.
⁴ Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁵ Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. rwinter@bwh.harvard.edu.
⁶ Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. rwinter@bwh.harvard.edu.

PMID: 40563066
DOI: 10.1007/s10620-025-09172-y

Abstract

We present a case of a female with complex pediatric-onset stricturing small bowel and colonic Crohn's disease. She was refractory to multiple advanced therapies, requiring dual therapy with risankizumab and upadacitinib to induce healing. Using intestinal ultrasound to monitor her response to therapy, we ultimately de-escalated to risankizumab monotherapy due to a reduction of inflammatory burden. We present this case to highlight the use and importance of intestinal ultrasound to guide changes in therapy, discussing its use in practice for patients with inflammatory bowel disease.

Keywords: Drug-induced amenorrhea; Drug-induced lupus; Inflammatory bowel disease; Infliximab; Intestinal wall thickness; Magnetic resonance enterography; Risankizumab; Upadacitinib.