Intestinal Point-of-Care Ultrasound at UPMC Children’s Enables Real-Time IBD Management

The Inflammatory Bowel Disease Center (IBD Center) at UPMC Children’s Hospital of Pittsburgh is now using intestinal point-of-care ultrasound as part of routine clinical care for pediatric IBD patients, changing and adding a real-time diagnostic tool in how disease activity is evaluated and managed.

Whitney Sunseri, MD, director, UPMC Children’s IBD Center, led the implementation after completing formal training in intestinal ultrasound and has integrated the technique directly into clinical workflows of the Center.

“With intestinal ultrasound, we have a powerful, yet noninvasive tool to help us understand whether a patient has active inflammation,” Dr. Sunseri says. “We can assess bowel wall thickness and hyperemia during the visit and use that information immediately to determine whether we need to escalate care, pursue endoscopy, continue current management, or otherwise.”

Jeffrey Rudolph, MD, chief, Division of Pediatric Gastroenterology, Hepatology and Nutrition, UPMC Children’s, supported development of the program and acquisition of the new ultrasound system.

“This was an important investment for the Division because it reflects how we want to improve patient care by bringing more advanced, disease-specific capabilities directly into the clinical setting and building programs that allow us to evaluate and manage patients more effectively,” Dr. Rudolph says.

Training and Implementation

Dr. Sunseri completed formal training in intestinal ultrasound through the International Bowel Ultrasound Group, including didactic coursework and hands-on training at centers in the United States and Europe.

During her training, Dr. Sunseri completed more than 100 supervised ultrasounds before obtaining certification in October 2025. Implementation of intestinal ultrasound in clinical care at the UPMC Children’s IBD Center began in February 2026, following Dr. Sunseri’s training and the Division’s acquisition of the mid-level ultrasound machine.

The ultrasound system is shared across the Division for additional gastrointestinal applications, including use by hepatology providers for monitoring conditions like Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), allowing the platform to support multiple clinical programs and extend its utility.

From Delayed Testing to Same-Visit Decisions

Before the introduction of intestinal ultrasound, assessment of a patient’s IBD activity relied heavily on laboratory studies and fecal calprotectin testing. Stool-based testing in particular introduces delays, requiring sample collection, processing time, and follow-up interpretation.

“In many cases, we were making decisions in stages,” Dr. Sunseri says. “We would order testing, wait for results, and then determine whether we needed to move forward with scopes or a change in therapy weeks later.”

Ultrasound has the ability to shift this sequence. During a routine visit, patients presenting with symptoms, including abdominal pain, rectal bleeding, or increased stool frequency can be assessed immediately. Increased bowel wall thickness or presence of hyperemia, both objective markers of active disease, supports escalation of care decisions, while normal findings allow Dr. Sunseri and the IBD Center team to defer more invasive evaluations with greater confidence.

The same approach is used in new patient evaluations, where ultrasound can help identify inflammatory changes during the initial visit and support the need for expedited diagnostic workup when indicated.

Measuring Inflammation Directly

Intestinal ultrasound focuses on two primary parameters of disease state or activity: bowel wall thickness and hyperemia. In pediatric patients, bowel wall thickness greater than approximately 2.5 millimeters is considered abnormal and a marker of active inflammation. Hyperemia is assessed using a modified Limberg scoring system, which categorizes the degree of blood flow within the bowel wall. These measurements allow Dr. Sunseri and colleagues to both establish the patient’s baseline and track changes over time.

“We are evaluating the same objective markers at each visit,” Dr. Sunseri says. “That allows us to determine whether inflammation is improving, stable, or progressing in response to therapy. And since we can see it in real time, we can make decisions in real time, speeding up changes or adjustments in care.”

Reframing Imaging in Pediatric IBD

Magnetic resonance enterography remains a necessary study for evaluating small bowel disease but it presents practical challenges for children – particularly very young patients. The study requires fasting, intravenous access, ingestion of oral contrast, and prolonged imaging time.

“Enterography is still an important part of care, but it is not an easy study for patients to tolerate,” Dr. Sunseri says. “Ultrasound allows us to obtain clinically relevant information without adding that burden if we don’t’ have to, and without delaying decision-making about our care plan.”

Because ultrasound is performed during routine clinic visits for inpatient admissions, it can change how patients and families engage with care. There is no preparation, no contrast administration, and no delay between imaging and interpretation. Findings can be reviewed in real time, allowing Dr. Sunseri to explain what is being measured and how it relates to disease activity.

“That real-time component changes the interaction with patients and families,” Dr. Sunseri says. “They can see what we are seeing and understand whether there is inflammation. It helps them follow the reasoning behind treatment decisions and can make the next steps of care more clear or understandable.”

Objective Monitoring in Acute Severe Ulcerative Colitis

Dr. Sunseri also uses intestinal ultrasound in the inpatient setting for children admitted with acute severe ulcerative colitis, where early assessment of treatment response can affect the timing of escalation. These patients are monitored using the Pediatric Ulcerative Colitis Activity Index, a validated scoring system that includes stool frequency, bleeding, abdominal pain, and other clinical measures. The score is useful, but interpretation can be difficult when symptoms change gradually or when the team is trying to determine whether a patient is beginning to respond to therapy.

Ultrasound adds an additional objective measure of response by showing whether bowel wall thickness and vascularity are improving after steroids, biologic therapy, or other treatments. In one recent patient with acute severe ulcerative colitis, Dr. Sunseri used ultrasound after a treatment change to assess response within 48 hours. The patient’s bowel wall thickness decreased from 3.8 millimeters to 2.8 millimeters, moving into the normal range, giving her and the team objective evidence that the therapy was working.

“In acute severe ulcerative colitis, we are often trying to decide whether we are seeing true improvement or whether we need to move to the next therapy,” Dr. Sunseri says. “When we can show that bowel wall thickness is improving over a short interval, it gives us objective evidence to support continuing the current approach. If the bowel wall thickness is increasing, that tells us the patient is not responding and that we need to change course.”

That information also has value for families. When a child is hospitalized with severe disease and discussions include additional escalation or possible colectomy, serial ultrasound can make the clinical trajectory easier to understand. Families can see whether inflammation is improving or worsening, rather than relying solely on symptom reports, laboratory values, or the passage of time.

Distinguishing Inflammation From Functional Symptoms

Intestinal ultrasound is also used to evaluate patients with symptoms that may not reflect active inflammation. Children with inflammatory bowel disease often have overlapping Irritable Bowel Syndrome (IBS), including intermittent diarrhea or abdominal discomfort.

“Not all symptoms in patients with IBD are due to active inflammation,” Dr. Sunseri says. “Ultrasound allows us to more rapidly determine whether there is objective evidence of inflammation at the time of symptoms.”

When imaging findings are normal, it allows Dr. Sunseri’s team to avoid unnecessary endoscopy or changes in therapy and instead manage symptoms of IBS overlap appropriately.

Expanding Access to Intestinal Ultrasound in the Region

Dr. Sunseri is currently the only provider in the Pittsburgh region trained to perform intestinal ultrasound for inflammatory bowel disease. Adult patients who require this evaluation have limited local access, and some have been referred outside the region.

The UPMC Children’s IBD Center and the UPMC adult gastroenterology teams are now working to establish a pathway for adult referrals. The plan is to begin with a half-day clinic once per month. At the same time, Dr. Sunseri is beginning to train other providers in the UPMC Children’s IBD Center to expand intestinal ultrasound capacity.

“We are building this in a way that allows us to grow within our program first, and then more broadly,” Dr. Sunseri says. “There is clear demand for intestinal ultrasound in the IBD patient community – children and adults – and the goal is to make it more accessible while maintaining consistency in how we perform and interpret results.”

Refer a Patient

For patient referrals or additional information about the UPMC Children’s IBD Center, please call 412-692-5180.