Multiparametric intestinal ultrasound in inflammatory bowel diseases: a narrative review

INTRODUCTION: Multiparametric intestinal ultrasound (MPUS) has emerged as a valuable, noninvasive tool for the diagnosis, monitoring, and phenotyping of inflammatory bowel diseases (IBD), offering real-time assessment of bowel wall structure, vascularity, and stiffness. AREAS COVERED: This review discusses the latest advancements in intestinal ultrasound, including contrast-enhanced ultrasound (CEUS), elastography, and ultrasound microvascular imaging (UMI). These techniques enhance the characterization of inflammation and fibrosis, help differentiate between inflammatory and fibrotic strictures, detect complications such as abscesses or phlegmons, and monitor therapeutic response. The narrative is based on a comprehensive analysis of recent literature identified through a PubMed search conducted up to September 2025. with a focus on clinical applicability, technical methodology, and current evidence supporting each modality. EXPERT OPINION: MPUS represents a transformative evolution in IBD imaging, particularly in point-of-care and longitudinal disease management. Despite its strong potential, widespread adoption is limited by technical variability, operator dependency, and lack of standardization. Future integration into clinical practice will require multicenter validation, standardized protocols, and training programs. The development of AI-assisted tools and targeted CEUS may soon elevate MPUS from a structural to a functional and molecular imaging modality, opening the door to personalized, precision-based IBD care.