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Background Inflammatory bowel diseases (IBD) are chronic conditions that require multiple endoscopic and imaging assessments. Recent guidelines recommend bowel ultrasonography (BUS) as a complimentary imaging technique to assess transmural and extraintestinal lesions. The aim of the present study was to evaluate the accuracy of BUS in predicting the need to step-up therapy in IBD patients. Methods 117 IBD patients were included in the study (28 diagnosed with ulcerative colitis, 89 with Crohn’s disease). Following bowel ultrasound features bowel ultrasound features have been investigated: bowel wall thickness, loss of wall stratification, presence of bowel wall Doppler signal, the presence of hyperechoic spots inside the bowel wall, the irregularity of the external layer of the wall, the presence of creeping fat (mesenteric hypertrophy), the presence of visible lymph nodes. Patients were followed up for the next 6 months and data regarding their therapy was noted. Results During follow-up, therapeutic step-up, or biological treatment intensification (study outcome) were considered in 49.5% of cases in our study group. In a univariate analysis all the studied bowel ultrasound features but not the disease phenotype were significantly associated with the outcome. In the multivariate analysis only mean bowel wall thickness (&amp;lt;0.0001) and the presence of bowel wall Doppler signal (0.007) were independent predictors. Using the logistic regression prediction model, a score to evaluate the need of IBD treatment intensification could be calculated - Bowel Ultrasound Score (BU Score). The AUROC of the new BU score as a predictor for treatment intensification at 6 months in patients with IBD is 0.92, with a sensitivity of 84% and a specificity of 89%, indicating a good clinical utility. For the same outcome, AUROC for CRP was 0.81 whereas for fecal calprotectin was 0.85. Conclusion As the “treat to target concept” is the currently accepted novel treatment paradigm, incorporating BUS in IBD patients monitoring (BU score) provides an easy-to-use and readily available tool to stratify patients in need for therapeutic intensification.

P400 Bowel ultrasonography, a non invasive easy-to-use method to predict the need to step-up therapy in inflammatory bowel disease patients