No Prep, No Anesthesia: Why Intestinal Ultrasound Is the New Frontier of IBD Monitoring
By
Rebecca Kaplan
Published on October 25, 2026
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Inflammatory bowel disease (IBD) is a chronic gastrointestinal (GI) condition in which symptoms may come and go, but inflammation can persist even when you feel fine.
Traditional disease monitoring in IBDs like Crohn’s disease and ulcerative colitis (UC) relies on blood work, imaging tests like magnetic resonance enterography (MRE) and computed tomography (CT) scans, and procedures like colonoscopy and endoscopy. While generally safe, these tests can be hard for some people with IBD.
But recently, intestinal ultrasound, an imaging technique that can be done during a routine visit, has become more common. Here, experts discuss what intestinal ultrasound entails and why your doctor might use it to keep tabs on GI inflammation.
What Is Intestinal Ultrasound, and Why Is It Helpful for Monitoring IBD?
Intestinal ultrasound is a noninvasive imaging tool that allows gastroenterologists to accurately assess IBD activity in their office. “It allows you to get a point-of-care assessment of a patient's bowel in real-time," says Michael Winter, MD, a gastroenterologist specializing in IBD at Dartmouth Health in Lebanon, New Hampshire, and the chief program officer for the Intestinal Ultrasound Group of the United States and Canada (iUSCAN).
First discussed in medical literature in the 1970s, intestinal ultrasound has been a regular part of clinical care in Europe, Australia, Canada, and Japan for years, but U.S. adoption began only in the last few years.
In an ultrasound, a probe that’s moved around the surface of the abdomen uses sound waves to produce live images of the bowel. “If there’s inflammation, your intestines get swollen, they get thickened … and they get bruised or have increased blood flow. Those are the two main signs of inflammation [that we can see on intestinal ultrasound],” says Michael Dolinger, MD, the director of the pediatric inflammatory bowel disease program at NYU Langone in New York City and a cofounder and the chief operating officer of iUSCAN.
Intestinal ultrasound can also reveal common IBD complications, such as scar tissue, narrowed parts of the bowel (strictures), abnormal connections between the intestine and other organs (fistulas), or fluid-filled pockets (abscesses).
How Does Intestinal Ultrasound Compare With Other Methods for Monitoring IBD?
- CT scans produce detailed images of the entire bowel but expose you to radiation and use contrast dye that some people cannot tolerate.
- MRE closely examines the small intestine but is expensive, time-intensive, and requires fasting and oral contrast (which some people cannot tolerate). It can also be difficult for people with implanted medical devices or claustrophobia, and may be contraindicated in others.
- Colonoscopy uses a flexible tube with a light on the end to show the entire large intestine and end of the small intestine (terminal ileum) and allows for biopsies and cancer screening. But it is invasive, requires sedation and bowel preparation using laxatives, and carries a small risk of bleeding, infection, or a tear in the bowel wall.
Intestinal ultrasound avoids many of these challenges. It’s safe, noninvasive, requires no fasting or bowel preparation, and provides results quickly. “Intestinal ultrasound has truly transformed the way I care for my patients with inflammatory bowel disease,” says Bincy Abraham, MD, the director of the Fondren Inflammatory Bowel Disease Program at the Underwood Center for Digestive Disorders at Houston Methodist Hospital in Texas and the president of the Strategic Alliance for Intercultural Advocacy in GI (SAIA-GI).
“Since it allows me to assess disease activity in the bowel in real-time during a clinic visit, my patients feel they have immediate answers and reassurance of how treatment is going. They also feel quite engaged in their care,” she says.
Research shows intestinal ultrasound is nearly as accurate as MRE scans. In one study of people with Crohn’s disease, MRE accurately detected disease activity in the terminal ileum 97 percent of the time, while intestinal ultrasound detected it 94 percent of the time. Other research on Crohn’s has found that intestinal ultrasound performs better than MRE at detecting inflammation and thickening of the bowel wall, narrowing (stenosis), and fluid buildup (ascites).
Intestinal ultrasound does have some limitations: It is not ideal for examining the entire small intestine and is not a replacement for colonoscopy when screening for colorectal cancer. Instead, it serves as a complementary tool. “Ultrasound is like taking a magnifying glass to specific parts of the bowel, and an MRE or CT scan is like you’re in a plane flying over a city and you can see the entire map and landscape of everything. Both are extremely valuable,” says Dr. Dolinger.
What to Expect During an Intestinal Ultrasound
An intestinal ultrasound is performed during a regular doctor’s appointment and requires no special preparation. “It takes anywhere from 5 to 30 minutes and is typically painless. It’s quite similar to having an abdominal examination from a physician, just instead of using your hands, you’re using an ultrasound probe,” says Dr. Winter.
You lie down on the examination table and lower your waistband slightly to expose your abdomen. The doctor applies ultrasound gel and moves the probe along the colon, ending at the terminal ileum. Real-time images of the bowel appear on a screen for you and your doctor to view and discuss together.
“It immediately helps patients translate what they’re feeling into understanding what’s actually happening inside their body,” says the chief strategy officer for iUSCAN, David T. Rubin, MD, who is also chief of the section of gastroenterology, hepatology, and nutrition and the director of the inflammatory bowel disease center at University of Chicago Medicine.
Is an Intestinal Ultrasound Right for You?
For most people with IBD, an intestinal ultrasound is a good first choice for disease monitoring. “We use ultrasound as the quarterback of our care. We use it to triage, not to avoid [other monitoring methods],” says Dolinger.
But certain factors can make intestinal ultrasound more challenging, including someone’s specific body composition, extensive previous bowel surgery, rectal and perianal disease, or pouch assessments.
If you’re interested in intestinal ultrasound, ask your provider whether it would be a good fit for you and how to access it.
EDITORIAL SOURCES
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Resources
- Plevris N et al. Disease Monitoring in Inflammatory Bowel Disease: Evolving Principles and Possibilities. Gastroenterology. April 2022.
- How Is IBD Diagnosed? Crohn’s & Colitis Foundation.
- Intestinal Ultrasound Gains Ground in IBD Care: Houston Methodist's Role in Expanding Training. Houston Methodist. October 13, 2025.
- Dolinger MT et al. Intestinal Ultrasound as a Non-Invasive Tool To Monitor Inflammatory Bowel Disease Activity and Guide Clinical Decision Making. World Journal of Gastroenterology. April 21, 2023.
- Pal P et al. Intestinal Ultrasound (IUS) in Inflammatory Bowel Disease (IBD): A New Skill for Gastroenterologists. World Gastroenterology Organisation. December 2024.
- Intestinal Ultrasound for Inflammatory Bowel Disease (IBD). UChicago Medicine.
- Younis MY et al. The Current Role of Imaging in the Diagnosis of Inflammatory Bowel Disease and Detection of Its Complications: A Systematic Review. Cureus. November 6, 2024.
- Abdominal and Pelvic CT. Radiological Society of North America. June 15, 2026.
- Magnetic Resonance Enterography. Mayo Clinic. August 19, 2026.
- Liao CH et al. Factors Affecting Perception and Acceptance of Colonoscopy in Patients With Inflammatory Bowel Disease. Preventive Medicine Reports. January 2025.
- Dolinger MT et al. Current and Novel Uses of Intestinal Ultrasound in Inflammatory Bowel Disease. Gastroenterology & Hepatology. August 2023.
- Cleveland NK et al. The Arrival of Intestinal Ultrasound for Inflammatory Bowel Disease Care in the United States. Gastroenterology and Hepatology. March 1, 2023.
- Maccioni F et al. Evolving Role of Intestinal Ultrasound in the Evaluation of Crohn’s Disease: A Clinical- Radiological Perspective. Radiology Open. December 2026.
- Lu C et al. Review Article: Extending the Frontiers of Intestinal Ultrasound Knowledge, Performance and Expansion. Alimentary Pharmacology and Therapeutics. November 14, 2025.
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