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Cytomegalovirus infection associated with inflammatory bowel disease
1Medizinische Klinik für Gastroenterologie, Infektiologie, Rheumatologie, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Abstract:
Refractory colitis in patients with inflammatory bowel disease is a complicated clinical disorder that might, in some patients, even necessitate surgery. Hence the diagnosis of additional complications is of utmost importance. Colitis mediated by cytomegalovirus is one such complication. The high seroprevalence and latent nature of cytomegalovirus, with the possibility of viral replication without mediating disease, poses a real challenge for the diagnosis of cytomegalovirus-mediated colitis. The challenge in daily clinical practice is to distinguish cytomegalovirus replication from cytomegalovirus-mediated colitis in patients with inflammatory bowel disease who have refractory colitis. This Review discusses the scientific literature and provides a diagnostic and therapeutic algorithm for clinical practice.
Insights
Diagnosing cytomegalovirus-mediated colitis in inflammatory bowel disease patients with refractory colitis is challenging. This review offers a diagnostic and therapeutic algorithm to differentiate viral replication from active disease.
Area of Science:
- Gastroenterology
- Virology
- Immunology
Background:
- Refractory colitis in inflammatory bowel disease (IBD) presents complex clinical challenges, sometimes requiring surgical intervention.
- Cytomegalovirus (CMV) infection is a significant complication in IBD patients, complicating disease management.
- Distinguishing CMV replication from CMV-mediated colitis is crucial for effective treatment in refractory IBD.
Purpose of the Study:
- To review the current literature on cytomegalovirus-mediated colitis in IBD.
- To provide a practical diagnostic and therapeutic algorithm for clinicians.
- To address the diagnostic challenges posed by CMV in refractory colitis.
Main Methods:
- Comprehensive review of existing scientific literature.
- Analysis of diagnostic criteria for CMV colitis.
- Development of a clinical algorithm based on evidence.
Main Results:
- Cytomegalovirus (CMV) can replicate in IBD patients without causing active colitis, complicating diagnosis.
- Distinguishing active CMV colitis from mere viral shedding is critical for appropriate immunosuppressive therapy.
- Early and accurate diagnosis is key to preventing complications and guiding treatment decisions.
Conclusions:
- A clear diagnostic and therapeutic strategy is needed for CMV in refractory IBD.
- The proposed algorithm aims to improve patient outcomes by facilitating accurate diagnosis and targeted therapy.
- Further research may refine diagnostic approaches and treatment protocols for CMV-mediated colitis in IBD.