Changes in Splanchnic Hemodynamics in Inflammatory Bowel Disease Non-Invasive Assessment by Doppler Ultrasound Flowmetry

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Abstract
An increase in splanchnic blood flow in both arterial and venous beds has been demonstrated in inflammatory bowel disease (IBD) by means of angiographic and scintigraphic studies. Doppler ultrasound (US) enables a non-invasive evaluation of splanchnic arterial inflow in the superior mesenteric artery (SMA) and of venous outflow in the portal vein. The aim of this study was to assess the role of Doppler US in detecting changes in the hemodynamic variables measured in patients with IBD. Forty-five patients with IBD were studied, including 22 with Crohn's disease (CD) and 23 with ulcerative colitis (UC), and compared with 45 matched normal subjects. The mean velocity of portal flow (Vmean) and the resistance index (RI) of the SMA were evaluated by Doppler US. In CD the Vmean of portal flow was significantly higher in patients with active disease than in controls (p < 0.001) and patients with inactive disease (p < 0.001). The RI of the SMA was significantly lower in active disease than in controls (p < 0.005), but no significant difference was noted between active and inactive CD. Also in UC, the Vmean of portal flow was significantly higher in patients with active disease than in controls (p < 0.01) and patients with inactive disease (p < 0.05). The RI of the SMA was significantly lower in active disease than in controls (p < 0.005) and in patients with inactive disease (p < 0.005). Doppler follow-up studies were carried out in 10 patients after initiation of treatment. A normalization of hemodynamic variables occurred in 7 of 10 patients in whom clinical and laboratory remission was noted (p < 0.01 for Vmean and p < 0.05 for RI). This preliminary study suggests the utility of Doppler US in the non-invasive evaluation of hemodynamic changes in IBD. Whether this can translate into a helpful tool for the assessment of disease activity and patient management requires further investigation.