Review article: cytomegalovirus and inflammatory bowel disease

Aliment Pharmacol Ther. 2015 Apr;41(8):725-33. doi: 10.1111/apt.13124. Epub 2015 Feb 16.

Abstract

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.

Publication types

  • Review

MeSH terms

  • Antiviral Agents / therapeutic use
  • Biopsy
  • Colectomy
  • Colitis, Ulcerative / epidemiology
  • Cytomegalovirus Infections / drug therapy
  • Cytomegalovirus Infections / epidemiology*
  • Cytomegalovirus Infections / physiopathology
  • Drug Resistance
  • Humans
  • Immunohistochemistry
  • Immunosuppression
  • Inflammatory Bowel Diseases / drug therapy
  • Inflammatory Bowel Diseases / epidemiology*
  • Inflammatory Bowel Diseases / physiopathology
  • Monocytes / immunology
  • Prevalence
  • Real-Time Polymerase Chain Reaction
  • Severity of Illness Index
  • Steroids / pharmacology

Substances

  • Antiviral Agents
  • Steroids