Review article: cytomegalovirus and inflammatory bowel disease

Abstract

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.

Risk Factors and Clinical Outcomes Associated with Cytomegalovirus Colitis in Patients with Acute Severe Ulcerative Colitis

“…1,3,29 Our current analyses show that CMV colitis is an independent parameter associated with a poorer disease course in patients with ASUC. Consistent with the results of previous studies, 3,29 CMV colitis reduced the response rate to intravenous steroids in the present study patients. However, there is an ongoing debate about the significance of CMV colitis, namely whether CMV is a pathogen that aggravates ASUC or whether it simply reflects disease severity.…”

“…However, there is an ongoing debate about the significance of CMV colitis, namely whether CMV is a pathogen that aggravates ASUC or whether it simply reflects disease severity. 1,3 To ascertain this in our present investigation, we performed multivariate analysis after adjustment for the response status to steroids and found that CMV colitis was an independent risk factor for rescue therapy but not for colectomy. Previous studies have indicated that the diagnosis of CMV colitis by the detection of inclusion bodies on H&E staining is the most clinically relevant of all diagnostic methods.…”

“…[1][2][3] However, accumulating evidence suggests that CMV is pathogenic and increases the risk of colectomy 4-7 and mortality 5,8 in patients with ulcerative colitis (UC). The clinical significance of CMV colitis is more relevant in patients with acute severe UC (ASUC), which is a potentially life-threatening condition with a high colectomy rate and a measurable mortality rate.…”

Diagnóstico y manejo de colitis ulcerosa grave: Una mirada actualizada

“…Estudios de cohorte informan una prevalencia de reactivación viral que varía entre 4,6 y 25% [38][39][40][41][42][43][44] .…”

Management of Acute Severe Colitis in Children With Ulcerative Colitis in the Biologics Era

“…19 Clinical suspicion of CMV viremia should be directly suspected when IBD patients present with prominent systemic symptoms, especially fever, lymphadenopathy, splenomegaly, leucopenia, and mild hepatitis. 20 However, CMV colitis need not present such features. Criscuoli et al reported that CMV may be a cause of refractory UC in an adult population, with detection in histologic specimens of 11 patients (46%) with toxic megacolon compared with 2 (9%) severe UC matched controls (P = .0078) and 7 (14%) unmatched controls (P = .003).…”