Use of Water Ingestion in Small Intestine Ultrasound

Small Intestine Contrast Ultrasonography (SICUS) is an ultrasound-based method that explores bowel loops, and is able to identify wall thickness, intestinal motility, bowel wall vascularity and complications such as stenosis or dilatation. Previous studies have utilised oral ingestion of an oral contrast solution (usually PEG dissolved in a volume of water ranging from 250 to 1000mL), in order to increase the sensitivity of ultrasound, especially in stricture detection. Parameters that have been improved include lumen distension to better delineate bowel wall layers, and improved peristalsis. Diffusion of this technique has been limited, in part due to PEG-based agents being costly, time consuming and are not tolerated well in some individuals. Utilisation of water as oral contrast may improve patient tolerability and therefore increase uptake of water ingested intestinal contrast ultrasound (WICUS) as a technique in routine clinical practice. The investigators aim to study the tolerability and the improvement of image quality utilising water as an oral contrast for intestinal ultrasonography.

Inclusion Criteria: All consecutive patients at baseline scan with: * Confirmed or suspected Crohn's disease with small bowel involvement * Increased bowel wall thickness (\>3mm) of the terminal ileum * Suboptimal luminal distension of the terminal ileum 3cm proximal to ICV and 1cm proximal to diseased segment (defined as \<8mm) * All patients with an ileo-colic anastomosis Exclusion Criteria: * Presence of an ostomy * Adequate distension at baseline scan * Patients with ileo-rectal anastomosis or IPAA