Patient Perspectives of Intestinal Ultrasound in IBD: A Quantitative Evaluation of Satisfaction and Diagnostic Preference

Abstract

Purpose

Intestinal ultrasound (IUS) has been shown to be an accurate, non-invasive, point-of-care tool for monitoring disease activity in inflammatory bowel disease (IBD). While its diagnostic performance is well-established, there is a notable gap in research related to patient perspectives regarding the role of IUS in IBD management, including its impact on the patient-provider relationship, which has not been previously studied.

Methods

We conducted a quantitative study with a 21-question Likert scale (0–10) survey administered to patients undergoing IUS during routine IBD clinic visits. Survey questions assessed four domains: (1) patient experience with IUS, (2) preference of IUS versus other diagnostic modalities, (3) impact on the patient-provider relationship, and (4) the enhancement of disease understanding.

Results

Fifty-seven patients completed the survey. Overall, patients reported high satisfaction with IUS (mean score: 9.15), preferred IUS over bloodwork, stool testing, CT/MRI, and colonoscopy (mean score: 7.64), and felt it positively impacted patient-provider relationship (mean score: 8.07), and disease understanding (mean score: 7.74). IUS was strongly preferred over stool testing and colonoscopy (mean scores: 10 for both). Patients on steroids reported greater enhancement of the patient-provider relationship (8.70 vs. 7.82, p = 0.03), and those with Crohn’s disease reported greater improvement in disease understanding compared to ulcerative colitis (8.16 vs. 7.18, p = 0.04).

Conclusions

Patients expressed high satisfaction with IUS across all survey domains. These findings support the broader use of IUS into IBD care, highlighting its value not only as a diagnostic tool but also in enhancing patient experience and engagement.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1007/s10620-026-10070-0.

Introduction

Inflammatory bowel disease (IBD), encompassing Crohn’s disease (CD) and ulcerative colitis (UC), requires ongoing assessment of disease activity to guide treatment and monitor response. Traditional monitoring tools such as colonoscopy, stool biomarkers, and cross-sectional imaging are effective, but are often associated with significant patient burden, including invasiveness, bowel preparation, radiation exposure, and delays in results. These limitations have prompted interest in noninvasive, point-of-care modalities that can improve patient experience while maintaining diagnostic accuracy.

Intestinal ultrasound (IUS) has emerged as a valuable, non-invasive tool that provides real-time information with high sensitivity and specificity pertaining to a patient’s individual IBD disease activity [1–4]. Several studies have shown the utility of IUS in longitudinal disease monitoring [3–5]. Consensus definitions of IUS treatment response, transmural healing, transmural remission, and recommended timing for serial assessments as well as established validated scoring systems are leading to standardization of documentation and interpretation of IUS [6–8]. As noted in the systematic review by Goodsall et al., a few studies have compared patient preference for IUS to other diagnostic modalities [9]. However, there is a paucity of literature available related to the patient’s perspective regarding IUS itself and its impact on disease understanding and patient-provider relationships as well as very little data from the United States.

The purpose of this study is to further understand patient perspectives of IUS as it relates to other diagnostic modalities, experience of the ultrasound process, patient-provider relationship, and understanding of one’s own disease status. Via survey, we aimed to determine the attitudes and opinions of patients with IBD who underwent an IUS during an outpatient clinic visit to the Vanderbilt IBD Clinic.

Methods

Study Design

This study was a cross-sectional, convergent mixed-methods study, surveying patients with IBD about their perspectives on having IUS as part of their IBD clinic visit. A 21-question survey was developed, with each item rated on a 0–10 Likert scale, where 0 indicated strong disagreement and 10 indicated strong agreement, and scores closer to 10 favored the use of ultrasound. The survey was designed to assess multiple dimensions of the patient experience and was organized into four conceptual domains: (1) patient experience with IUS (Questions 1–3, 8), (2) diagnostic preference comparing IUS to other modalities (Questions 4–7), (3) impact on the patient-provider relationship (Questions 9–15), and patient disease understanding (Questions 16–21) (See Supplemental Materials Table 1). Survey questions were designed to evaluate comfort, convenience, perceived diagnostic value, and the influence of IUS on communication and engagement with care.

Table 1 .

Demographic and clinical characteristics of patients with IBD undergoing intestinal ultrasound

Patient demographics
Patients	N = 57
Sex
Male	22 (38.6%)
Female	35 (61.4%)
Age
< 40 yo	29 (50.9%)
≥ 40 yo	28 (49.1%)
Mean (SD)	42.7 (14.7)
Median (IQR)	38.2 [32.3, 50.5]
IBD subtype
Crohn’s disease	34 (59.6%)
Ulcerative colitis	22 (38.6%)
Indeterminate colitis	1 (1.8%)
Disease duration
Mean (SD)	10.8 (10.53)
Median (IQR)	7.6 [2.3, 18.4]
History of bowel surgery
Yes	42 (73.7%)
No	15 (26.3%)
Steroids at time of IUS
Yes	16 (28.1%)
No	41 (71.9%)
Exposure to therapy
0–1 Therapies	26 (45.6%)
2 + Therapies	31 (54.4%)

SD Standard deviation, IQR Interquartile range, IUS Intestinal ultrasound

Recruitment and Data Collection

All participants were patients with IBD seen at the IBD Clinic at Vanderbilt University Medical Center (VUMC) who had an IUS as part of their clinic visit anytime from January 2021 to March 2025. Exact time interval between IUS and survey completion was not systematically recorded. IUS examinations were performed as part of routine clinical care using a standardized transabdominal technique. No intravenous or oral contrast agents were administered. Additional approaches, including transvaginal or perineal ultrasound, were not utilized in this study. Only patients with access to the electronic patient portal were eligible for inclusion in the study. All participants were initially contacted via telephone to obtain verbal consent prior to sending a link to the REDCap eConsent and survey through the electronic patient portal. Of the 356 patients who met criteria for our study and were consented for the study, 57 patients completed the survey after receiving the survey via the electronic patient portal. Once participants completed the eConsent and survey, patient charts were retrospectively reviewed for demographic and clinical data, including age, sex, IBD subtype, length of disease, current and previous IBD medications, and history of intestinal surgery. The number of prior IUS examinations per participant was not incorporated into subgroup analyses.

Informed consent and survey responses were collected using Research Electronic Data Capture (REDCap), a secure, web-based application designed for building and managing online surveys and databases. All data provided by participants were stored within the REDCap system. This platform is compliant with HIPAA regulations and is approved for research use by Vanderbilt University Medical Center (VUMC) [10, 11].

Statistical Analysis

Statistical analysis of the survey data was completed with R data analysis. Descriptive statistics were used to summarize survey responses and retrospective chart review. In evaluation of the survey domains, the second domain comparing IUS to other diagnostic modalities as listed in questions 4–7 was reverse-scored for more consistent evaluation, with scores closer to 10 favoring intestinal ultrasound regarding the statement. Pearson correlation analyses were used to assess relationships among the survey question domains. Non-parametric tests, including Wilcoxon rank sum tests, were employed to compare scores across survey question domains, demographic and clinical subgroups, including IBD subtype and current medication use. Data comparisons included age (≥ 40 versus < 40 years old), sex, subtype of IBD (Crohn’s disease and ulcerative colitis), history of bowel surgery, steroid use at time of IUS, patients with exposure to more than one biologic, duration of disease (≥ 1 year versus < 1 year) to determine if certain groups may have responded to questions differently. A p-value less than 0.05 was considered statistically significant.

Results

Participant Characteristics

The study included 57 patients with IBD who underwent an IUS at the Vanderbilt IBD Clinic. Most participants were female (61.4%), with a mean age of 42.7 years (SD 14.7). The average duration of disease was 10.8 years (SD 10.5), with a median (IQR) of 7.6 years (2.3, 18.4). Most participants had Crohn’s disease (59.6%), followed by ulcerative colitis (38.6%), and a small proportion with indeterminate colitis (1.8%). Forty-two patients had a history of surgery (73.7%), and 28.1% were on corticosteroids (prednisone or budesonide) at the time of the survey. Over half of the cohort (54.4%) had exposure to two or more advanced therapies. A summary of these demographic characteristics is presented in Table 1.

Overall Survey Outcomes

Overall, patients reported high satisfaction with intestinal ultrasound across all measured domains, with a mean of 8.15 (SD 1.07). The mean scores for each question domain are reported in Table 2, as the results suggested near-normal distribution. The mean score for patient experience (Questions 1–3, 8) was 9.15 (SD 1.31), indicating a highly positive experience. The reversed-coded items comparing ultrasound to other diagnostic modalities (Questions 4–7) had a slightly lower mean score of 7.64 (SD 1.62), suggesting more variability in how patients perceive ultrasound relative to other tests, although scores were high overall. Scores for the patient–provider relationship domain (Questions 9–15) averaged 8.07 (SD 1.44), while patient understanding of their disease (Questions 16–21) had a mean score of 7.74 (SD 1.63). Figure 1 shows the distribution of scores across the four survey domains. All domains scored well above the neutral threshold, with the highest ratings for patient experience with ultrasound and slightly lower scores for comparisons with other modalities.

Table 2.

Mean survey scores across domains evaluating patient experience, diagnostic preference, patient-provider relationship, and disease understanding following intestinal ultrasound

Survey results	Mean (SD)
Overall composite score	8.15 (1.07)
Patient perception of IUS	9.15 (1.31)
Preference of diagnostics	7.64 (1.62)
IUS preferred to bloodwork	6.25 (2.46)
IUS preferred to stool testing	8.23 (2.43)
IUS preferred to CT or MRI	7.49 (2.25)
IUS preferred to colonoscopy	8.61 (2.21)
Patient-provider relationship	8.07 (1.44)
Patient’s own disease understanding	7.74 (1.63)

SD Standard deviation, CT Computed tomography, MRI Magnetic resonance imaging

Fig. 1.

Violin plots of overall survey scores for each domain of questions. IUS Intestinal Ultrasound

Data Analyses

To further understand the patient opinion of IUS compared to other diagnostics, we also report the results for each question in the second domain, questions 4–7, also seen in Table 2. Patients expressed preference for IUS over other diagnostic modalities. This is especially true when comparing IUS to stool testing and colonoscopy where the median score for both was 10. Preference for IUS over bloodwork was more modest, however, with a mean of 6.25 (SD 2.46). Figure 2 illustrates the distribution of patient preferences for IUS compared to other modalities. Most responses cluster above the neutral midpoint (score = 5), indicating strong preference for ultrasound over stool testing and colonoscopy, with more variability for bloodwork and CT/MRI.

Fig. 2.

Violin plots for survey scores showing preference for intestinal ultrasound over other diagnostic modalities. IUS Intestinal Ultrasound, CT Computed Tomography, MRI Magnetic Resonance Imaging

Correlation analysis of scores across each survey domain revealed a strong relationship between patient-provider relationship and patient disease understanding (r = 0.86), suggesting that when patients feel they have a strong relationship with their provider, they also report a better understanding of their disease. There was a moderate association between the positive patient experience of IUS and improved patient-provider relationship (r = 0.28) or patient disease understanding (r = 0.31). However, there was a weak association between IUS preference over other diagnostic modalities and other survey domains (r = 0.18–0.21).

Wilcoxon rank sum tests were utilized to test the distribution of scores among different groups. These subgroups, with data obtained at the time of the IUS examination, included age, sex, disease type, disease duration, steroid use, surgical history, and exposure to advanced therapy. Across subgroup analyses, most comparisons showed no statistically significant differences in survey scores. However, several notable patterns emerged. Patients with ulcerative colitis reported higher preference for IUS over colonoscopy compared to those with Crohn’s disease (mean 9.5 vs 8.0, p = 0.006). Patients with Crohn’s disease reported higher disease understanding compared to patients with ulcerative colitis after undergoing IUS (8.16 vs. 7.18, p = 0.04). Participants on steroids rated the patient-provider relationship more favorably than those not on steroids (mean 8.7 vs 7.8, p = 0.03). No subgroup of patients had significantly greater scores when comparing IUS to other diagnostic modalities.

Discussion

Though the treat to target paradigm has been endorsed by international groups and emphasized in the most recent ACG guidelines, monitoring of response to various therapies can present financial and logistical challenges to patients. IUS has emerged as a reliable, non-invasive, point-of-care alternative for disease assessment. Here we present patient’s perceptions of IUS in the United States, with patients reporting high levels of satisfaction across all survey domains. These findings indicate that patients felt favorably toward the use of IUS in their care, perceiving it as a valuable diagnostic tool that contributed positively to their understanding of their disease, their relationship with their provider, and their overall experience. The violin plots in Fig. 1 show consistently high ratings across all domains, with the greatest density for patient experience and slightly broader distributions for patient-provider relationship and disease understanding. These visual patterns reinforce that positive perceptions of IUS are not limited to a subset of respondents but are broadly shared, supporting its role as a patient-centered diagnostic tool in the outpatient IBD setting.

Although several exploratory subgroup analyses were performed, most comparisons did not reveal statistically significant differences in survey scores. This consistency suggests that positive perceptions of IUS are broadly shared across demographic and clinical characteristics, reinforcing its general acceptability as a diagnostic tool among patients with IBD. The lack of strong subgroup effects indicates that the appeal of IUS may be driven by its inherent advantages, such as its noninvasiveness, convenience, and immediacy, rather than patient-specific factors. These findings support the integration of IUS into routine care for diverse IBD patient populations [2].

A consistent theme in the literature is that patients generally prefer non-invasive monitoring, IUS in particular, and our findings closely align with this. In a systematic review of 10 studies, Goodsall et al. concluded that adults with IBD preferred non-invasive investigations over endoscopy, and when assessed, IUS was repeatedly associated with greater acceptability and satisfaction than endoscopy or other imaging modalities [9]. This is consistent with our cohort’s strong preference for IUS, especially over colonoscopy and stool testing. Other reviews similarly position IUS as an accurate, reproducible, point-of-care modality whose lack of preparation and immediate results likely contribute to higher patient ratings, mirroring the high domain scores we observed [12, 13]. In the METRIC trial, patients rated ultrasound more acceptable than MRE and far more acceptable than colonoscopy, with shorter recovery and greater willingness to repeat [14]. Another recent study across 2 IBD centers similarly found that IUS was preferred over other disease monitoring strategies [15]. This further parallels our participant’s higher scores for IUS relative to other diagnostic tests.

Beyond preference, research indicates that IUS can enhance disease understanding and influence care, which resonates with our demonstration that patient understanding and patient-provider relationship are tightly linked. In a prospective cohort, adding IUS during clinic visits improved patients’ understanding and changed clinician assessments and management decisions; our data similarly suggest that IUS during clinic visits is associated with better disease understanding [16]. Another study showed IUS to be highly acceptable and preferred in practice, reinforcing the generalizability of our IUS findings and supporting the broader integration of IUS into routine, patient-centered IBD care [13]. This is echoed in a pediatric study that found greater perceived disease understanding among patients and caregivers with the integration of IUS [17]. Overall, research indicates that IUS can enhance disease understanding and influence care, which resonates with our demonstration that IUS improves patient disease understanding. This finding may be what links our data’s strong correlation between disease understanding and patient-provider relationship, something not explored explicitly in previous studies.

The correlation analysis revealed a strong relationship between patient-provider relationship and patient understanding of their disease (r = 0.86), suggesting that effective communication and trust between patients and providers may play a critical role in enhancing disease comprehension. To our knowledge, however, this is the first study to evaluate the impact of IUS on the patient-provider relationship explicitly. Our findings demonstrate that IUS may also strengthen communication and trust between patients and clinicians. By providing real-time visualization of disease activity during clinic visits, IUS facilitates shared decision-making and enhances patient confidence in treatment plans. This unique contribution underscores the potential of IUS not only as a diagnostic tool but also as a means of improving patient engagement and satisfaction in routine care. Overall, the benefits of IUS do not go unnoticed by patients themselves, as this survey has ultimately demonstrated.

In review of the minimal literature aiming to elucidate patient perspectives with IUS, most studies focus on the preference for IUS over other diagnostic tools and may address the patient experience of IUS as it pertains to discomfort and tolerability [9, 13–18]. Two studies additionally probed into how IUS impacted a patient’s disease understanding. For example, the University of Alberta pediatric study by Hudson et al. asked patients and caregivers how IUS helped them understand their IBD, disease location, and management recommendations, with a majority responding favorably [17]. An Australian study, Rajagopalan et al., surveyed patients with IBD on the impact of IUS on the patient understanding of their IBD, with questions on disease extent, activity, need for therapy, treatment adherence, and overall knowledge [18]. Our study also probes into the patient opinion on the IUS experience, preference among diagnostic tools, and disease understanding, with similar findings, further supporting the utility of IUS.

This study has several limitations that should be considered when interpreting the findings. First, the sample size was relatively small and single center potentially introducing institutional bias and limiting applicability to broader patient populations. Survey responses may also be subject to recall bias or response bias, as participants completed the survey after their clinic visit rather than during or immediately following the intestinal ultrasound. The time interval between completion of the IUS and survey response was not standardized or recorded and perceptions could have evolved over time. While this may introduce recall bias, it is likely to be non-directional and therefore unlikely to systematically overestimate or underestimate patient-reported perceptions of IUS. Differences between participants who had undergone a single versus multiple IUS examinations were not evaluated, which limited the ability to assess how repeated exposure may influence patient perceptions.

Future research should aim to expand the scope and rigor of patient experience assessments with IUS. Increasing the sample size and including multiple centers and age groups would improve statistical power and generalizability. Adding more qualitative measures, through qualitative interviews or open-ended survey questions, could provide more insight into patient perceptions to better contextualize quantitative findings. Longitudinal designs, including tracking patients over time and validating the survey instrument through psychometric testing, would clarify how perceptions of IUS evolve with disease course, treatment changes, and repeated exposure to IUS. Together, these improvements would support a more comprehensive understanding of how IUS contributes to patient-centered care in IBD.

Conclusion

In this survey conducted in a tertiary academic IBD center in the United States, patients reported positive experiences with IUS and perceived improvements in understanding their disease and the relationship with their provider. Notably, this is the first study to demonstrate that IUS may strengthen patient-provider communication by enabling real-time visualization of disease activity and supporting shared decision-making during clinic visits. IUS was also preferred over other diagnostic testing options currently available in the management of IBD. The overall high scores suggest that IUS is a valuable part of outpatient IBD management. These results underscore the potential of IUS as a patient-centered diagnostic tool that complements clinical decision-making while reducing procedural burden.

Supplementary Information

Below is the link to the electronic supplementary material.

Author Contribution

Specific Author Contributions: Kacie H Denton: Study design, data analysis, writing of the manuscript; critically reviewed, revised, and approved the final manuscript. James C Slaughter: Data analysis, critically reviewed, revised, and approved the final manuscript. Audrey Bennett: Critically reviewed, revised, and approved the final manuscript. Elizabeth A Scoville: Critically reviewed, revised, and approved the final manuscript. Robin L Dalal: Critically reviewed, revised, and approved the final manuscript. Sara Horst: Data analysis; critically reviewed, revised, and approved the final manuscript. Dawn B Beaulieu: Critically reviewed, revised, and approved the final manuscript. David A Schwartz: Critically reviewed, revised, and approved the final manuscript. Baldeep S Pabla: Study design, data analysis; writing of the manuscript, critically reviewed, revised, and approved the final manuscript. Dr. Pabla is the guarantor of the manuscript.

Funding

No funding was received for conducting this study.

Data Availability

No datasets were generated or analyzed during the current study.

Declarations

Conflict of interest

Kacie H Denton: Reports no conflicts of interest. Chris C Slaughter: Reports no conflicts of interest. Audrey Bennett: Reports consulting fees from Celltrion, which is unrelated to this work. Elizabeth A Scoville: Reports no conflicts of interest. Robin L Dalal: Reports consulting fees from Abbvie, which is unrelated to this work. Sara Horst: Reports consulting fees from Abbvie, Takeda, Biocon, Pfizer, and Johnson & Johnson, and educational grant support from Abbvie and Takeda, all of which are unrelated to this work. Dawn B Beaulieu: Reports consulting fees from Abbvie, Takeda, Johnson & Johnson, Zymfentra, and Institute of Functional Medicine, all of which are unrelated to this work. David A Schwartz: Reports consulting fees from Abbvie, Janssen, Takeda, Avbios, Olympus, all of which are unrelated to this work. Baldeep S Pabla: Reports consulting fees from Abbvie, advisory board fees from Johnson & Johnson, Astellas, and Bristol Myers Squibb, and speaker fees from Prometheus, Eli Lilly, all of which are unrelated to this work.

Ethical approval

The study received approval from the VUMC Institutional Review Board in January 2025. A standardized electronic consent form, approved for use at VUMC, was embedded within the survey and required completion before completion of the survey. All participants were informed that their involvement was entirely voluntary and that they could withdraw from the study at any time without consequence. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Consent to participate

A standardized electronic consent form, approved for use at VUMC, was embedded within the survey and required completion before completion of the survey. All participants were informed that their involvement was entirely voluntary and that they could withdraw from the study at any time without consequence.