Outcome of Cytomegalovirus Colitis in Inflammatory Bowel Disease with Different Regimes of Ganciclovir

Abstract

BACKGROUND Cytomegalovirus (CMV) infection is common in individuals with inflammatory bowel disease (IBD) and is responsible for relapse, increased severity, and poor outcome if left untreated. Ganciclovir is the mainstay of treatment but data regarding its use, mode of administration, and duration of treatment is poorly described. We reviewed the practice of treating CMV colitis with different regimes of ganciclovir at a district NHS hospital to compare the clinical outcome. METHODS 35 patients with IBD and concurrent diagnosis of CMV infection were evaluated. The parameters studied were clinical outcome in term of clinical response, length of hospital stay, readmission, or colectomy with three different regimes of ganciclovir, in addition to treatment for IBD. RESULTS 35 patients with IBD (ulcerative colitis = 23, Crohn’s disease = 5, Indeterminate colitis = 7) and positive diagnosis of CMV infection were studied. Clinical outcome with two weeks of intravenous (IV) ganciclovir regime was superior than one week of IV ganciclovir and two weeks of oral Valganciclovir in term of clinical response on day 15 (95.8% vs 74%, 24.3%, respectively p = 0.45) and colectomy rate within 3 months (6.25% vs 27.3%, vs 25%, respectively). CONCLUSION CMV colitis is associated with poor outcome in patient with IBD if left untreated. 2 weeks IV ganciclovir was associated with a better outcome than 1 week of IV treatment or oral treatment.

Cytomegalovirus and Inflammatory Bowel Diseases (IBD) with a Special Focus on the Link with Ulcerative Colitis (UC)

“…This success has been confirmed in other case reports or analysis of limited cohorts of patients ( Table 3 ). The duration of antiviral treatment should be at least of two weeks and, if possible, by intravenous route [ 157 ], as the inflammation of the gut may compromise the drug absorption. For the management of such patients, we proposed an algorithm that considers the CMV viral load in inflammatory tissue ( Figure 3 ).…”

The Trends of Immunohistochemistry for Tissue-Invasive Cytomegalovirus in Gastrointestinal Mucosal Biopsies

“…15 The potential negative impact of CMV on IBD warrants the requests for CMV IHC testing in biopsies. 15,16 However, the prevalence of CMV reactivation/ infection in patients with IBD is still uncertain, since prior studies have evaluated only selected patients or used different methods to diagnose CMV infection. 17 Previous research has suggested a range of 4% to 16% for CMV infection rate in patients with IBD.…”

Management of Hospitalized Patients with Inflammatory Bowel Disease and CMV Infection or Clostridium Difficile Infection

“…However, in a small retrospective study in patients with IBD and CMV colitis, a 2-week treatment with oral valganciclovir was associated with more colectomies and decreased clinical response than 2-week intravenous ganciclovir [63].…”