Endoscopic diagnosis of cytomegalovirus infection of upper gastrointestinal tract in solid organ transplant recipients: Hungarian single‐center experience

Péter, Antal; Telkes, Gábor; Varga, Marina; Sárváry, Enikő; Kovalszky, Ilona

doi:10.1111/j.1399-0012.2004.00230.x

Cited by 50 publications

(33 citation statements)

References 23 publications

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“…Wang et al [1] reported odynophagia/dysphagia (44%) and epigastric pain (31%) as the most common symptoms in CMV esophagitis patients. In contrast, Péter et al [10] concluded that abdominal pain (39%), anemia/GI bleeding (20%), and nausea/vomiting (13%) were the most frequently complaints in patients with CMV gastritis/duodenitis. Moreover, in up to 7% of the cases, upper GI CMV disease may have an asymptomatic presentation [10] .…”

Section: Discussionmentioning

confidence: 91%

“…In contrast, Péter et al [10] concluded that abdominal pain (39%), anemia/GI bleeding (20%), and nausea/vomiting (13%) were the most frequently complaints in patients with CMV gastritis/duodenitis. Moreover, in up to 7% of the cases, upper GI CMV disease may have an asymptomatic presentation [10] . Our study was consistent with these results as dysphagia (40%) and abdominal pain (29%) were also the most common symptoms in CMV esophagitis and gastritis patients, respectively.…”

Section: Discussionmentioning

confidence: 91%

“…However, the literature is scarce regarding CMV disease of the upper GI tract. Two of the largest studies concerning upper GI CMV disease are from Wang et al [1] and from Péter et al [10] . The first study identified 16 patients with CMV esophagitis and the second included 91 patients with CMV gastritis and/or duodenitis.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Cytomegalovirus Disease of the Upper Gastrointestinal Tract: A 10-Year Retrospective Study

Marques¹,

Carmo²,

Gomes

et al. 2017

GE Port J Gastroenterol

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Background and Aims: Cytomegalovirus (CMV) disease of the gastrointestinal (GI) tract is a major cause of morbidity and mortality in immunocompromised patients. The colon is the most commonly affected site, and the literature is scarce regarding CMV disease of the upper GI tract. Therefore, our study aimed to evaluate the clinical and endoscopic features of upper GI CMV disease. Methods: This 10-year retrospective study included all patients with a histopathological diagnosis of upper GI CMV infection. Patients' clinical, endoscopic, therapy, and follow-up data were collected from medical records. Results: Twelve patients with histopathologically proven upper GI CMV disease were identified (age 61 ± 18 years, 50% men). Most of the patients were immunocompromised (75%) due to acquired immunodeficiency syndrome (AIDS), malignancy, and/or immunosuppressive therapy. In the remainder (25%), the disease occurred in the absence of immunodeficiency and immunosuppression. Three patients (all with AIDS) presented with disseminated CMV infection. In the majority of the cases (83%), upper GI CMV disease was symptomatic, and the most common clinical presentations were odynophagia/dysphagia (25%) and nausea/vomiting (25%). Endoscopically, there were 5 cases of esophagitis (42%) and 7 cases of gastritis (58%). The lower esophagus (33%) and the gastric antrum (42%) were the most frequently affected GI sites. Regardless of the location, mucosal ulceration was the most common endoscopic finding (75%) and was associated with very deep ulceration resembling cavitation in 2 cases. Other endoscopic features were mucosal edema, hyperemia, and nodularity (25%). Eleven patients (92%) received antiviral treatment (duration 26 ± 12 days). The 1-month and 1-year mortality rates were 16.7 and 25%, respectively. Conclusions: Upper GI CMV disease can occur in the absence of immunodeficiency and immunosuppression. It is usually symptomatic, and mucosal ulceration is often evident at endoscopy. It is associated with significant mortality; therefore, early diagnosis and adequate antiviral treatment are essential.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 91%

See 1 more Smart Citation

Cytomegalovirus Disease of the Upper Gastrointestinal Tract: A 10-Year Retrospective Study

Marques¹,

Carmo²,

Gomes

et al. 2017

GE Port J Gastroenterol

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show abstract

“…The presence of CMV was not associated with ulcer, with the occurrence of erosions, oesophagitis, the macroscopic findings of inflammation or with metaplasia and atrophy (p values p = 0.65; 0.52; 0.89; 0.81; 0.29; 0.25, respectively). The presence of H. pylori was not correlated with a positive PCR for CMV, p = 1.0 [23].…”

Section: Infectionsmentioning

confidence: 97%

Helicobacter pylori before and after the kidney transplantation

Telkes

2011

IMAS

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Abstract:Renal disease is often accompanied by significant gastrointestinal symptoms, and Helicobacter pylori is related to these disorders. There is a paucity of data about the endoscopic findings of kidney recipients. HLA-class II genes have been repeatedly investigated for predisposition to H. pylori infection. The aim was to evaluate the H. pylori infection rate, study the relationship between HLA antigens and H. pylori, and assess the post-transplant gastrointestinal disorders. Data of 709 uraemic patients were collected for seroepidemiologic study; 58.7% of patients were male and the mean age was 45.1 years. The endoscopic results of 543 kidney transplant recipients were analysed; their mean age was 49.5 years and 56.9% were male. Of 709 patients, 49.37% were seropositive for H. pylori. Prevalence of H. pylori decreased strongly with the year of birth. Significant difference was observed in the occurrence of HLA-DR12 according to H. pylori serology. Twenty-nine per cent of endoscopies showed ulcer disease in the first 3 months, more frequent (p = 0.0014) than later. The presence of H. pylori was verified in 20.9% of cases, less than in the general, and in the uraemic population (p < 0.0001). There was no association between the presence of H. pylori and ulcer (p = 0.28). Steroid pulse treatment for rejection was not associated with more ulcers (p = 0.11).

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“…In the diagnosis of gastrointestinal CMV infection, the detection of the virus in the mucosa is essential. Peter et al [7] recommended qualitative PCR of biopsy material. They evaluated 200 solid organ transplant recipients with upper gastrointestinal symptoms.…”

Section: Commentmentioning

confidence: 99%

Gastric ulcer despite no acid in a renal allograft recipient: what is the link?

Canbakan

Mızrak²,

Keven

et al. 2005

Nephrology Dialysis Transplantation

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A 33-year-old female patient with end-stage renal disease underwent successful cadaveric renal transplantation in February 2005. The patient's immunosuppressive regimen comprised thymoglobulin (ATG Fresenius AG, Germany) 100 mg/day for induction, corticosteroid (methylprednisolone 500 mg/day for 3 days and followed by oral prednisolone 1 mg/kg/day), mycophenolic acid (MPA) (Myfortic, Novartis Pharma Stein A.G., Switzerland) 1440 mg/day. The cytomegalovirus (CMV) status of the patient was seronegative (RÀ), whilst it was seropositive for donor (Dþ). The allograft immediately functioned, and serum creatinine levels decreased to 0.9 mg/dl. Tacrolimus was initiated at a dose of 0.1 mg/kg/day 3 days after the operation, and thymoglobulin was used for 5 days. The tacrolimus dose was titrated based on trough levels. Trimetoprimsulphametoxozole, flucanozole and acyclovir were given for prophylactic therapy. Omeprazole was also given for gastroduodenal protection. There were no postoperative complications, and the patient was discharged 9 days after the operation.The patient was readmitted to the hospital 6 weeks after the transplantation, because of nausea, vomiting, severe malaise and abdominal pain. On physical examination, the patient was afebrile and haemodynamically stable. The abdomen was flat and soft with minimal epigastric tenderness. The remainder of the examination was unremarkable. Initial laboratory data showed a haemoglobin level of 11.2 g/dl, total white blood cell count of 6300/mm 3 and platelet count of 165.000/mm 3 . A chest X-ray showed clear lung fields. Serum electrolytes, blood urea nitrogen and creatinine were normal. The serum ALT level was

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Endoscopic diagnosis of cytomegalovirus infection of upper gastrointestinal tract in solid organ transplant recipients: Hungarian single‐center experience

Abstract: Qualitative PCR is an accurate method for the detection of CMV in the mucosa of the GI tract. Further investigations are needed for determination of the exact pathological role of detected CMV.

Cited by 50 publications

References 23 publications

Cytomegalovirus Disease of the Upper Gastrointestinal Tract: A 10-Year Retrospective Study

Cytomegalovirus Disease of the Upper Gastrointestinal Tract: A 10-Year Retrospective Study

Helicobacter pylori before and after the kidney transplantation

Gastric ulcer despite no acid in a renal allograft recipient: what is the link?

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