Summary Background The association between ulcerative colitis and cytomegalovirus (CMV) has been recognised for over 50 years; and the role of CMV in ulcerative colitis in general, and steroid resistance in particular, remains a topic of ongoing controversy. The outcome for patients with CMV reactivation appears worse than that for patients without reactivation, but it is not entirely clear whether CMV is a contributor or a bystander and if treatment with anti‐virals alters the course of inflammatory bowel disease (IBD). Aim To review the role of CMV associated with IBD, including epidemiology, clinical features, diagnosis and management strategies. Methods By reviewing literature available on CMV associated with IBD in adult patients. A PubMed literature search was performed using the following terms individually or in combination: CMV colitis, cytomegalovirus colitis, IBD and CMV, CMV treatment. Results Cytomegalovirus reactivation is common in patients with severe colitis, with a reported prevalence of 4.5–16.6%, and as high as 25% in patients requiring colectomy for severe colitis. The outcome for this group of patients appears worse than that for patients without reactivation; however, reported remission rates following treatment with anti‐viral therapy are as high as 71–86%. Conclusions Evidence, although not conclusive, supports testing for CMV colonic disease in cases of moderate to severe colitis, by processing biopsies for haematoxylin and eosin staining with immunohistochemistry and/or, CMV DNA real‐time polymerase chain reaction; and if present treating with ganciclovir.

BACKGROUND: For patients with difficult venous access after long-term intravenous drug use, rapid point-of-care hepatitis C virus (HCV) RNA quantification in capillary whole blood with the Xpert® HCV Viral Load Fingerstick (VL FS) test (60 minutes) is a convenient and reliable method for diagnosing chronic HCV infection, monitoring treatment and detecting reinfection. However, an expensive GeneXpert® system must be available on site. In decentralised settings with a low case-load, dried blood spot (DBS) testing might be an alternative. METHODS: Between December 2019 and January 2021, patients with an indication for HCV RNA quantification and informed consent provided 100 µl capillary whole blood each for on-site Xpert® HCV VL FS testing (reference) and DBS testing in the laboratory. For the latter, 100 µl blood, collected with an EDTA Minivette®, were transferred to a Whatman® 903 filter card. After drying for at least 1 hour, the DBS sample was packed into a sealable plastic bag with desiccant and sent to the central laboratory of our hospital, where it was stored at –20°C. For HCV RNA extraction, the whole DBS was cut out with an 18-mm puncher and transferred into 1.3 ml guanidinium thiocyanate-containing buffer (provided by Cepheid®). After mixing and incubating at room temperature for 2–3 hours, 1 ml supernatant was analysed with the Xpert® HCV VL test (105 minutes) (filter paper absorbs 0.3 ml). RESULTS: Of 109 paired samples from 67 patients, 38 (34.9%) were positive with the Xpert® HCV VL FS test. Sensitivity and specificity of DBS testing were 89.5% (34/38; 95% confidence interval [CI] 75.9–95.8%) and 97.2% (69/71; 95% CI 90.3–99.2%), respectively. The six (5.5%) discordant results (four false negative, two false positive) all were observed in samples with HCV RNA detectable below the limit of quantification after 2–8 weeks of pan-genotypic direct-acting antiviral treatment or 5 weeks after acute hepatitis C in a patient clearing HCV spontaneously. Quantifiable results (n = 30; 16 genotype 1, 7 genotype 3, 4 genotype 4, 1 genotype 1a and 3a, 2 unknown; HCV RNA range: 2.74–6.66 log IU/ml) correlated well (R2 = 0.981). On average, uncorrected DBS test results were 1.30 ± 0.14 log IU/ml lower than Xpert® HCV VL FS test results (~42 μl instead of the expected 1000 μl plasma used). Storage of DBS samples at room temperature for 7 days before freezing reduced HCV RNA by 0.29 ± 0.12 log IU/ml. CONCLUSION: HCV RNA can reliably be quantified with the Xpert® HCV VL test in capillary dried blood spot samples. Thus, access to capillary HCV RNA quantification for diagnosing chronic HCV infection, monitoring treatment and detecting reinfection can be extended to decentralised settings with a low case load.

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IntroductionThe prevalence of metabolic bone disease (MBD) in Type 3 Intestinal Failure (IF) has been reported at 84% (1) but it is unclear if long term home parenteral nutrition (HPN) is associated with a consistent decline in bone mineral density (2). The aim of this study was to evaluate the prevalence of MBD and the progression of BMD in a large cohort of patients with CIF managed at a national referral centre.MethodThe prevalence of MBD in patients requiring HPN was evaluated retrospectively from a maintained database at a national U.K. referral unit in 2016. BMD was measured using DEXA scan and WHO criteria were used to categorise patients into normal (T score −1 and above), osteopenia (T score between −1 and −2.5), and osteoporosis (T score −2.5 and below). BMD progression was assessed by reviewing follow up DEXA scan results. Patient demographics along with HPN requirements and underlying disease were recorded.Results140 patients (mean age 54 years; 87 female)) with CIF had a DEXA scan performed. 85.7% patients were dependent on PN for calories and 11.4% were fluid dependent only.106 (75.7%) patients had a diagnosis of MBD (58 (41%)) osteoporosis; 48 (34.3%) osteopenia). 34 (24.3%) patients had a normal BMD.47 patients had follow up of BMD with a 2nd DEXA bone scan (time between DEXA scans, mean=2.4 years, min=1, max=5). Deterioration in BMD was demonstrated in 12 (26%) patients with change in WHO classification (7=osteoporosis from osteopenia; 5=osteopenia from normal). 34 (72%) showed no change in classification (osteoporosis n=21, osteopenia n=11, normal n=2). Only 1 (2%) patient had improvement in classification from osteoporosis to osteopenia.Aetiology of IF was classified into intestinal dysmotility (20%); post-operative surgical complications (26.4%); Crohn’s disease (32.9%); ischaemia (18.6%) and malignancy (2.1%). Prevalence of MBD differed between groups, with Crohn’s patients demonstrating the highest prevalence of MBD, 98% (52% osteoporosis, 46% osteopenia).ConclusionWe report a MBD prevalence in patients with CIF of 75.7%, comparable to other series),1 with a quarter of patients demonstrating a decline in T score. These data support the need for surveillance and treatment of MBD in patients needing HPN.2 References. Pironi L, et al. Clin Nutr2002;21:289e96.. Pironi L, et al. Clin Nutr2016; 35: 247–307.Disclosure of InterestNone Declared