S4949 Point of Care Intestinal Ultrasound Facilitates Treatment Acceptance in Ulcerative Colitis: A Case Report

Introduction: Nonadherence and reluctance to initiate maintenance therapy in ulcerative colitis remain common barriers to optimal disease control. Point-of-care intestinal ultrasound is a noninvasive and immediate tool for assessing mucosal inflammation and may have an underexplored impact on patient engagement. We present a case in which real-time visualization of appendiceal orifice inflammation via intestinal ultrasound (IUS) led to a pivotal shift in treatment acceptance after years of refusal. Case Description/Methods: A 60-year-old man with a 12-year history of appendiceal orifice (AO) and left-sided ulcerative colitis had recurrent symptoms historically controlled with 5-aminosalicylic acid and occasional corticosteroids. Despite persistent low-grade endoscopic inflammation (Mayo 1), he declined all maintenance therapies, emphasizing lifestyle modifications instead. At a routine follow-up, he was asymptomatic, with a Simple Clinical Colitis Activity Index of 1 and normal C-reactive protein. However, fecal calprotectin had increased to 244 µg/g (previously 113 µg/g). Point-of-care intestinal ultrasound was performed during the consultation. The left colon showed mildly increased bowel wall thickness - BWT (3.03 mm) with preserved stratification. The appendix appeared enlarged (6.5 mm), with BWT and prominent submucosa at the cecum. Real-time imaging demonstrated these changes to the patient, particularly the inflammation adjacent to the AO, consistent with historical colonoscopic findings. A subsequent colonoscopy confirmed Mayo 1 activity in the rectum and Mayo 2 inflammation at the AO. After visualizing the IUS findings, the patient expressed concern and agreed to initiate oral therapy with CurQD™ for the first time. Follow-up IUS and calprotectin are planned in 3–4 months. Discussion: Even though the option of using a nutraceutical (CurQD™) certainly played a role in the patient’s decision, this case illustrates the potential of point-of-care IUS not only as a diagnostic tool but as a catalyst for shared decision-making in ulcerative colitis. Real-time visualization of inflammation may enhance patient understanding and motivate behavior change, particularly in individuals skeptical of chronic treatment. While IUS is typically used for disease monitoring, its role in patient-centered communication and adherence promotion merits further attention. This case exemplifies how seeing their own inflammation may turn a reluctant patient into an engaged partner in care.