Revolutionizing Crohn's disease monitoring: The emerging role of intestinal ultrasound

Intestinal ultrasound (IUS) is increasingly recognized as a valuable tool in the monitoring of Crohn's disease (CD), offering a non-invasive, real-time assessment of transmural inflammation. Unlike conventional endpoints based on clinical scores, biomarkers, or mucosal evaluation, IUS allows direct visualization of bowel wall changes, enabling earlier detection of treatment response and more accurate prognostic assessment. IUS has demonstrated good diagnostic performance for the detection of strictures, penetrating complications, and postoperative recurrence. The development of advanced modalities such as contrast-enhanced ultrasound (CEUS) and elastography has further expanded its potential, particularly in differentiating inflammatory from fibrotic lesions - an emerging clinical need in the context of anti-fibrotic therapies. Evidence suggests that IUS findings can influence therapeutic decisions in routine practice, supporting treatment escalation, de-escalation, or switching in a timely and objective manner. Special applications, including transperineal ultrasound and use during pregnancy, reinforce the versatility and safety of IUS in challenging clinical scenarios. While technical limitations persist in certain patient subgroups, IUS remains a repeatable, accessible, and well-tolerated imaging modality that complements other diagnostic tools. As artificial intelligence enhances image interpretation and quantitative analysis, IUS is poised to become a cornerstone of precision medicine in CD. Its capacity to guide timely, individualized decisions makes it an essential component of modern disease monitoring and treatment optimization strategies.