Intestinal ultrasound (IUS) is an accurate tool to identify and follow up patients with chronic intestinal diseases (IBD). The use of IUS to obtain objective measurements of disease activity for monitoring patients with IBD and to guide their clinical management has become a cornerstone in the management of IBD patients, particularly those with Crohn’s disease. Indeed, among cross-sectional imaging techniques, IUS is non-invasive, easily repeatable, requires no special preparation, and is cost-effective. It has increasingly been recognized as a valuable diagnostic and monitoring tool for guiding therapeutic and surgical decisions in these patients. The most accurate IUS parameters for identifying active disease include the degree of bowel-wall thickening, the presence of bowel-wall hyperemia, and alterations in the echo pattern, as they correlate strongly with endoscopic activity. For this reason, these parameters have been incorporated into several predictive scoring systems. Additionally, mesenteric hypertrophy, the presence of free fluid within the bowel loops, and the presence of enlarged mesenteric lymph nodes are considered useful additional parameters to identify an active disease.