DOI: https://doi.org/10.22263/2312-4156.2025.5.87
I.А. Rutskaya1, S.I. Pimanov2
Ultrasound Colour Doppler Mapping of the colon wall in patients with Clostridioides difficile enterocolitis of various severity
1Vitebsk Regional Clinical Infectious Diseases Hospital, Vitebsk, Republic of Belarus
2Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
Vestnik VGMU. 2025;24(5):87-94.
Abstract.
The severity determination of clostridial infection (CDI) is of fundamental importance in the choice of treatment. The criteria for grayscale echographic diagnosis of severe course of Clostridioides difficile (Cl. difficile) colitis have been developed, but the possibilities of using ultrasound Colour Doppler Mapping (CDM) in this case have not been described. In ulcerative colitis and Crohn’s disease, increased blood flow in the intestinal wall is an indicator of inflammation.
Objectives. To study the features of the colon wall blood flow according to the standardized ultrasound CDM data in patients with clostridial colitis both with and without COVID-19.
Material and methods. 98 patients with CDI and 103 patients with CDI in combination with COVID-19 were examined. Ultrasonography (US) was performed using 5.0 MHz convex and 10.0 MHz linear transducers. Blood flow in the colon wall was assessed using the B. Limberg scale.
Results. The correlation between the severity of CDI and the degree of the colonic wall vascularization according to the Colour Doppler Mapping is moderate, and in combination of CDI with COVID-19 is weak. In case of moderate clostridial colitis Limberg-0 type was more frequent among patients with CDI without COVID-19. In all other cases the presence of COVID-19 in a patient had no significant effect on the degree of the intestinal wall vascularization, Negative clinical and laboratory dynamics of CDI was associated with a decrease in the colon wall vascularization. In severe CDI blood flow in the inflamed colon wall was registered more often than in extremely severe course of the disease.
Conclusions. The estimation of blood flow in the colon wall according to B. Limberg scale cannot be used in clinical practice as an indicator of the Cl. difficile colitis severity.
Keywords: ultrasonography, enterocolitis, Clostridioides difficile, Colour Doppler Mapping, COVID-19.
References
1. Ivashkin VT, Lyashenko OS, Drapkina OM, Alekseeva OP, Alekseenko SA, Andreev DN, i dr. Practical recommendations of the Scientific Community for the Promotion of the Clinical Study of the Human Microbiome, the Russian Gastroenterological Association and the Russian Society for the Prevention of Non-Communicable Diseases on the diagnosis and treatment of Clostridioidesdifficile-associated disease in adults. Rossiiskii Zhurnal Gastroenterologii Gepatologii Koloproktologii. 2023;33(3):85-119. (In Russ.). doi: http://dx.doi.org/10.22416/1382-4376-2023-33-3-85-119
2. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. British Medical Journal. 2020 Mar:368:m1295. doi: http://dx.doi.org/10.1136/bmj.m1295
3. Rutskaya IA. Ultrasound signs of Costridioides difficile-induced enterocolitis at its different severity of course in patients with COVID -19. Vestnik Vitebskogo Gosudarstvennogo Meditsinskogo Universiteta. 2024;23(1):77-87. (In Russ.). doi: http://dx.doi.org/10.22263/2312-4156.2024.1.77
4. Rutskaya IA. Enterocolitis caused by Clostridioides difficile: echographic characterization. Vestnik Vitebskogo Gosudarstvennogo Meditsinskogo Universiteta. 2024;23(5):86-93. (In Russ.). doi: http://dx.doi.org/10.22263/2312-4156.2024.5.86
5. Pimanov SI, Rutskaya IA. Possibilities of colonic ultrasound in determining the severity and prognosis of recurrent enterocolitis caused by Clostridioidesdifficile. Meditsinskaya Vizualizatsiya. 2025;29(2):39-50. (In Russ.). doi: http://dx.doi.org/10.24835/1607-0763-1489
6. Nylund K, Maconi G, Hollerweger A, Ripolles T, Pallotta N, Higginson A, et al. EFSUMB Recommendations and Guidelines for Gastrointestinal Ultrasound Part 1: Examination Techniques and Normal Findings (Long version). Ultraschall in der Medizin. 2017 Jun;38(3):e1-e15. doi: http://dx.doi.org/10.1055/s-0042-115853
7. Limberg B. Diagnosis of chronic inflammatory bowel disease by ultrasonography. Zeitschrift fur Gastroenterol. 1999;37(6):495-508. doi: http://dx.doi.org/10.1055/b-0034-80219
8. Pimanov SI. Ultrasound diagnostics in gastroenterology. Moscow, RF: Prakticheskaya meditsina; 2016. 416 р. (In Russ.).
9. Pimanov SI, Dikareva EA. Non-invasive assessment of ulcerative colitis activity in the selection of treatment regimen. Meditsinskii Sovet. 2023;(8):196-208. (In Russ.). doi: http://dx.doi.org/10.21518/ms2023-135
10. Cleveland NK, St-Pierre J, Kellar A, Rubin DT. Clinical Application of Intestinal Ultrasound in Inflammatory Bowel Disease. Current Gastroenterology Reports. 2024 Feb;26(2):31-40. doi: http://dx.doi.org/10.1007/s11894-024-00915-x
11. Bavrina AP, Borisov IB. Modern rules of application of correlation analysis. Meditsinskii Al'manakh. 2021;(3):70-79. (In Russ.).
12. Rebrova OYu. Statistical analysis of medical data. Application of Statistica application program package. Moscow, RF: MediaSfera; 2006. 312 р. (In Russ.).
13. Rutskaya IA, Pimanov SI. Prediction of recurrent Clostridioidesdifficile-induced enterocolitis by ultrasonographic characterization of the colon. Klinicheskaya Infektologiya i Parazitologiya. 2024;13(2):141-155. (In Russ.). doi: http://dx.doi.org/10.34883/PI.2024.13.2.042
14. Bryant RV, Friedman AB, Wright EK, Taylor KM, Begun J, Maconi G, et al. Gastrointestinal ultrasound in inflammatory bowel disease: an underused resource with potential paradigm-changing application. Gut. 2018 May;67(5):973-985. doi: http://dx.doi.org/10.1136/gutjnl-2017-315655
15. Rutskaya IA, Pimanov SI. Echographic characterization of the colon in patients with pseudomembranous colitis in COVID-19. Vestnik Vitebskogo Gosudarstvennogo Meditsinskogo Universiteta. 2021;20(6):56-66. (In Russ.). doi: http://dx.doi.org/10.22263/2312-4156.2021.6.56
Submitted 11.03.2025
Accepted 21.10.2025
Information about authors:
Irina А. Rutskaya – ultrasound diagnostics doctor, Vitebsk Regional Clinical Infectious Diseases Hospital, e-mail:
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S.I. Pimanov – Doctor of Medical Sciences, professor, head of the Chair of Internal Diseases & Ultrasound Diagnostics of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University.
