Small bowel imaging in inflammatory bowel disease

In the UK, ongoing delays in inflammatory bowel disease (IBD) diagnosis, driven in part by reliance on endoscopy, highlight the need for more efficient pathways. Improved understanding of a treat-to-target approach to the management of IBD aimed at transmural healing further challenges traditional investigative approaches. Advances in intestinal ultrasound (IUS) and magnetic resonance enterography (MRE) now enable accurate, non-invasive assessment of disease extent, activity and complications to be undertaken at frequent intervals, supporting a shift towards imaging-led care and an enhanced role for radiology.

This article reviews the current UK landscape, international guideline recommendations and the gap between evidence and practice, particularly the underutilisation of IUS despite its comparable diagnostic accuracy and advantages in speed, cost and patient acceptability. We outline best practice across the IBD pathway, from initial diagnosis through to longitudinal monitoring and transmural healing, and how this impacts the role of the radiologist in this field.
Drawing on our institutional experience, we describe how integrating IUS and MRE within a radiology-led workflow can streamline pathways, reduce diagnostic delays and support rapid clinical decision making within the multidisciplinary team. We argue that wider adoption of these approaches is essential to deliver timely, patient-centred and evidence-based IBD care.

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