ECCO-ESGAR-ESP-IBUS Guideline on Diagnostics and Monitoring of Patients with Inflammatory Bowel Disease: Part 1: initial diagnosis, monitoring of known inflammatory bowel disease, detection of complications - Report - MDSpire

ECCO-ESGAR-ESP-IBUS Guideline on Diagnostics and Monitoring of Patients with Inflammatory Bowel Disease: Part 1: initial diagnosis, monitoring of known inflammatory bowel disease, detection of complications

  • By

  • Torsten Kucharzik

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Stuart Taylor

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Mariangela Allocca

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Johan Burisch

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Pierre Ellul

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Marietta Iacucci

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Christian Maaser

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Pamela Baldin

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Gauraang Bhatnagar

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Shomron Ben-Horin

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Dominik Bettenworth

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Mallory Chavannes

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Ann Driessen

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Emma Flanagan

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Frederica Furfaro

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Giovanni Maconi

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Konstaninos Karmiris

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Amelia Kellar

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Isabelle De Kock

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Konstantinos Katsanos

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Uri Kopylov

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Cathy Lu

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Olga Maria Nardone

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Nurulamin M Noor

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Kerri Novak

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Paula Borralho Nunes

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Patrick van Rheenen

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Jordi Rimola

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Francesca Rosini

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • David Rubin

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Martina Scharitzer

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Jaap Stoker

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Mathieu Uzzan

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Stephan Vavricka

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Bram Verstockt

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Rune Wilkens

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Nina Zidar

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Alessandra Zilli

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Henit Yanai

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • Roger Feakins

  • the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • July 31, 2025

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ECCO-ESGAR-ESP-IBUS Guideline on Diagnosis and Monitoring of IBD Patients

Overview

This multi-society guideline provides comprehensive recommendations for the initial diagnosis, ongoing monitoring, and complication detection in inflammatory bowel disease (IBD) patients. It emphasizes the use of colonoscopy, imaging modalities, and histopathology, and addresses special clinical situations such as pregnancy and postoperative care.

Background

Inflammatory bowel disease requires accurate diagnosis and careful monitoring to optimize patient outcomes. The guideline is a joint effort by ECCO, ESGAR, ESP, and IBUS, updating the 2018 ECCO-ESGAR recommendations. It aims to guide multidisciplinary teams including gastroenterologists, radiologists, pathologists, and nurses on appropriate diagnostic tools and monitoring strategies. The guideline also identifies evidence gaps to stimulate future research.

Data Highlights

The guideline update involved 40 experts from 18 countries and three continents, with participation from patient representatives. A systematic literature review and two rounds of voting ensured consensus with at least 80% agreement. The guideline is divided into two parts: the first focusing on initial diagnosis, monitoring, and complication detection; the second on scoring systems and technical aspects.

Key Findings

  • Colonoscopy with terminal ileum intubation and mucosal biopsies remains the cornerstone for initial IBD diagnosis.
  • Diagnostic and monitoring tools include endoscopy, intestinal ultrasound, and magnetic resonance enterography (MRE).
  • Special considerations are provided for diagnostics during pregnancy, postoperative surveillance, and cancer screening.
  • The guideline update was developed through a rigorous methodology involving systematic literature review and expert consensus across multiple societies.
  • Evidence gaps were identified to guide future research priorities in IBD diagnostics and monitoring.

Clinical Implications

Clinicians should continue to rely on colonoscopy and histopathology as primary diagnostic tools for IBD while integrating advanced imaging modalities like intestinal ultrasound and MRE for monitoring disease activity and complications. Special patient populations, including pregnant women and postoperative patients, require tailored diagnostic approaches. Multidisciplinary collaboration is essential for optimal IBD management.

Conclusion

This updated multi-society guideline provides practical, evidence-based recommendations to improve the diagnosis and monitoring of IBD patients, supporting personalized and effective clinical care. Ongoing research is needed to address identified evidence gaps and refine diagnostic strategies further.

References

  1. ECCO-ESGAR-ESP-IBUS 2024 -- Guideline on Diagnosis and Monitoring of IBD Patients

Original Source(s)

ECCO-ESGAR-ESP-IBUS Guideline on Diagnostics and Monitoring of Patients with Inflammatory Bowel Disease: Part 1: initial diagnosis, monitoring of known inflammatory bowel disease, detection of complications

  • by Torsten Kucharzik, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Stuart Taylor, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Mariangela Allocca, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Johan Burisch, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Pierre Ellul, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Marietta Iacucci, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Christian Maaser, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Pamela Baldin, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Gauraang Bhatnagar, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Shomron Ben-Horin, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Dominik Bettenworth, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Mallory Chavannes, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Ann Driessen, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Emma Flanagan, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Frederica Furfaro, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Giovanni Maconi, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Konstaninos Karmiris, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Amelia Kellar, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Isabelle De Kock, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Konstantinos Katsanos, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Uri Kopylov, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Cathy Lu, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Olga Maria Nardone, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Nurulamin M Noor, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Kerri Novak, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Paula Borralho Nunes, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Patrick van Rheenen, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Jordi Rimola, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Francesca Rosini, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), David Rubin, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Martina Scharitzer, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Jaap Stoker, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Mathieu Uzzan, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Stephan Vavricka, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Bram Verstockt, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Rune Wilkens, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Nina Zidar, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Alessandra Zilli, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Henit Yanai, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO), Roger Feakins, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) the European Society of Pathology (ESP) and the International Bowel Ultrasonography Group (IBUS) on behalf of the European Crohn’s and Colitis Organisation (ECCO)

  • July 31, 2025

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